oa South African Medical Journal - Epilepsy : III : surgical treatment
The effects of surgery undertaken primarily for the treatment of epilepsy have been examined from a survey of a local series of 47 cases. and of 287 cases collected from the available literature. From this study a number of observations emerge. 1. The view that an upset of ' cerebral suspension' is of importance in the genesis of epilepsy is suspect. Surgical procedures undertaken on this basis are unsatisfactory. 2. Favourable results are noted where some definite surface vascular abnormality is dealt with. 3. The term cerebral ablation is more accurate than cortical ablation. It may include an epileptogenic zone or a zone through which certain features of the epileptic seizure are manifested. 4. The neurological deficit after planned cerebral ablation is relatively slight. 5. A number of cases die in spite of surgery and not on account of it. 6. The post-operative mortality for cerebral ablations of all types and from all causes is 3.5%. 7. To obtain satisfactory results it is necessary to carry out adequate removal of an epileptogenic zone. This may require very radical surgery. even to the removal of an entire cerebral hemisphere. with sparing of basal ganglia. in selected cases. 8. Cerebral ablation is sometimes of value in cases with grand mal. 9. In some cases petit mal appears to recede after drastic cerebral ablation. 10. Cerebral ablation sometimes exerts a beneficial effect on the mental equivalents and accompaniments of epilepsy. It seems likely that the seizures or equivalents, and the mental accompaniments of epilepsy share a common origin. 11. Cerebral ablation is most widely accepted in the treatment of focal and Jacksonian seizures. 12. In some cases medication can be withdrawn after successful cerebral ablation. but it is safer to consider this exceptional at the present time. 13. There is insufficient evidence to judge the value of section of neuronal pathways in the treatment of epilepsy. 14. Prefrontal leucotomy seems to have no place in the treatment of epilepsy.
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