Lessons from Amygdaloid Surgery in Long-Term Observation

Abstract

In my first paper on amygdaloid surgery in 1963 ⁵, it was clearly stated that the idea of the procedure was to minimize the surgical lesion to one certain structure in the depth of the temporal lobe in order to achieve relief of emotional and behavioural disturbances in epileptic patients in a wide sense, as well as of seizure problems. This thought might have followed, at least partially, the wide experiences of the Montreal school on temporal lobe epilepsy. For selection of cases for surgery, the first category was of those patients with severely disturbed behavior and with clinical epileptic seizures, either of the grand mal or temporal lobe type, and the second category were those with no clear clinical fits, but with a definite epileptic EEG. The third were those with neither clinical seizures nor epileptic EEG, but presenting various grades of non-progressive feeblemindedness, which suggested non-progressive organic brain-damage in those cases. Most of the cases in the latter had a history of encephalitic convulsions in early childhood. Non-epileptic patients with normal intellectual ability, and behaviour problems only, and those with major psychosis were excluded from my series.