Early American contributions to medical and surgical treatment of epilepsy
Edward J. FINE
From 1886 to 1910, American neurologists and neurosurgeons made significant contributions to the surgical and medical treatment of epileptics and to theories about the physiology and pathology of epilepsy. Five months after the British neurosurgeon Victor Horsley reported successful treatment of epilepsy by principles of cerebral localization and surgical removal of epileptic foci of several epileptics in June 1886, the American surgeon Roswell Park (1852-1915) localized the site of the lesion, performed craniotomy and successfully removed an “arachnoid cyst pressing on the left frontal and parietal lobes of a patient with daily focal motor seizures. In May 1888, William W. Keen (1837-1932) using Horsley’s principles of cerebral localization and a electrical stimulator, found the cortical location for movement of the fingers, removed scar tissue from this area and achieved control of a 20 year old man’s focal motor seizures without causing loss of function. In September 1888, Park, Keen and Charles K. Mills of Philadelphia organized an international seminar in Washington, DC on cerebral localization. There they, Victor Horsley, and David Ferrier interchanged ideas about the localization of the motor, sensory and speech areas of the human brain. In 1913, Park established principles for successful surgical treatment of epilepsy by urging early surgical management of epileptics who had intractable seizures after adequate medical treatment for 3 years and “that every scar is followed by another…and we are forced to make the second scar less irritating than the first”.
The establishment of Craig Colony in 1892, a comprehensive center for epileptics in Sonyea, NY by Buffalo philanthropist William P. Letchworth (1823-1910) and neurologist Fredrick Peterson (1859-1938), improved medical treatment of epilepsy by construction of buildings with safety features, and developed vocational training of epileptics. William P. Spratling (1862-1915), the first Medical Director of Craig Colony, established the first American residency program for training neurologists specializing in epilepsy, determined the therapeutic dose of triple bromide therapy, established that diet and exercise could reduce seizure frequency and severity. Spratling wrote the first American textbook (1904) based upon the principle of cortical genesis of seizures. His residents demonstrated the pathology of status epilepticus. James Munson (1881-1918), the neuropathologist to Craig Colony, discovered that epileptics with syphilis had endarteritis of cerebral blood vessels. He also established a national center for collection of injuries to epileptics. Letchworth and Spratling established the National Association for the Care and Treatment of Epileptics, the world’s first society for this disease in 1900.
Supported by Local Funds from Veterans’ Affairs Medical Center, Buffalo, NY.
Session IX -- Epilepsy Seminar
Montreal, Quebec, Canada