Abstract Details

Title ORIGINS OF ELECTROCORTICAL STIMULATION IN LOCALIZING SEIZURE FOCI FOR EXCISION

Topic Research Methodology, �鶹��ýӳ��, and History

Presentation(s) P7 - Poster Session 7 (5:30 PM-6:30 PM)

Poster/Presentation
Number 6-004

Objective To find the origins of using electrocortical stimulation to localize a seizure focus for successful removal

Background Prior to 1886 seizure foci were removed by cerebral cortex underlying skull fractures. dural scars with occasional success. In May 1886, Victor Horsley reported 100% seizure control or improvement by excising seizure foci identified by principles of cerebral localization and/or electro-cortical stimulation. We trace rapid adoption of this method by American surgeons.

Design/Methods Search: Pub Med, Index Cat, Archives of University of Buffalo

Results Victor Horsley with David Ferrier used ablation and electrical stimulation to map out on cortices of primates, loci of motor and sensory functions and summarized relation of human skull to underlying cortical structures in 1876. On November 16, 1886, Roswell Park of Buffalo, NY successfully localized and removed from left frontal cortex, the seizure focus of a man with aphasia, right arm paralysis. He had and motor seizures beginning in right hand after head injury. On May 30 1888, WW Keen, Jr. of Philadelphia used faradic electric stimulation from a sterilized moistened cotton tipped bipolar stimulator to right frontal motor cortex reproducing seizures that had began in fingers of his patient's left hand. Keen fashioned the stimulator as outlined in Horsley's publications. In spring 1891, Park used electrical stimulation to reproduce focal seizures in right frontal cortex in a female patient with Jacksonian seizures starting in left hand, not tolerating medical treatment. Her seizures were less frequent and severe, post-operation. By 1902 Park summarized criteria used for successful epilepsy surgery: evaluate patients for operation "early- only after 2 years unsuccessful medical therapy, can not provide cure without continued medical therapy, adherence to proper diet, daily exercise, avoidance of alcohol".

Conclusions Pioneer US surgeons rapidly and successfully adapted Horsley's method and emphasized principles of treatment that presaged modern therapy.

Authors/Disclosures
Edward J. Fine, MD, F�鶹��ýӳ�� (University Neurology, Northtowns) PRESENTER	Dr. Fine has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Friends of PALS (People with ALS.
	No disclosure on file