Development of surgical care for epilepsy: The contributions of Otfrid Foerster in Breslau and Wilder Penfield and his school in Montreal
It is one of the triumphs of modern neurosurgery that many patients with focal cerebral seizures can now be offered a cure or significant alleviation of this devastating condition by operation associated with low mortality and minimal risk of neurological or psychological deficits. In the 1920s in Breslau Otfrid Foerster (1878-1941), a neurologist by training, took up the scalpel in the cause of epilepsy. He made detailed analyses of seizure patterns and applied pneumoencephalography for preoperative localization. During surgery, he used local anesthesia, electrical stimulation, intraoperative hyperventilation and electrocorticography to help localize the epileptic focus. He produced detailed human brain maps as a result of his stimulation findings.
The interest of Wilder Penfield (1891-1976) in epilepsy began during his surgical work in New York in the 1920s. With a background of experience in the Spanish metallic techniques for staining glia he came to visit Foerster in 1928. From an examination of Foerster’s surgical specimens of meningocerebral cicatrix he postulated that a vasomotor reflex might be responsible for the initiation of seizures.. Penfield’s experience with Foerster came at a critical period in his career. At the Montreal Neurological Institute from 1934 onward, Penfield and his team continued their interest in vascular physiology of the epileptic brain. He adopted the technique of local anesthesia and electrical stimulation to map the human cortex but greatly extended Foerster’s work by discovering other areas of cortex subserving speech, hearing, vision and, perhaps most crucial of all, memory function. In the early 1950s Penfield and his associates defined the anatomical and pathological features of temporal lobe seizures originating in mesial temporal structures. They introduced what has since been referred to as the “Montreal procedure”, anterior temporal lobectomy including removal of the amygdala and hippocampus. This operation, adopted worldwide and enhanced by modern brain imaging techniques, has achieved postoperative cessation of seizures in more than 75% of patients. The successful development of epilepsy surgery serves as a prime example of a future informed by the past.
Session IX -- Epilepsy Seminar
Montreal, Quebec, Canada