Stereotactic Lesions for the Control of Intractable Epilepsy
Since 1955 somewhat over a thousand patients with Parkinsonism have been treated by stereotactic central lesions and the incidence of epilepsy has been very low, in fact in only two instances. In one of them it was strictly of a Jacksonian type and related to a cortical scar at the site of the burrhole in the premotor area. This is of interest in view of the observations of Williams (1965)—“Whilst focal attacks are confined to the cortex and subcortex focal attacks leading to a generalised convulsion abnormally activate the thalamic reticular structures which are essential to the development and diffuse spread of the general discharge. The thalamic mechanisms responsible must be intact for this process of activation and propagation for generalised epilepsy to occur.” Jinnai et al. (1963) attempted to define the conduction pathways of the focal epileptic convulsion in animal experiments and came to the conclusion that these might be interrupted with benefit at the most strategic point, namely the field of Forel (Fig. 1). He then applied this knowledge to some of his patients who were totally incapacitated and deteriorating because of uncontrolled severe and frequent epileptic attacks. The longterm results were promising and a number lost all major attacks. In these cases the pathways were interrupted by the stereotactic method using electrocoagulation.
KeywordsStatus Epilepticus Internal Capsule Intractable Epilepsy Posterior Limb Ventrolateral Nucleus
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