Faculty Bibliography

Multiple subpial transections (MST) were made in language cortex in three patients with medically refractory partial epilepsy. All patients were mapped with extra-operative stimulation using subdural grids over the dominant temporal, frontal and parietal convexity. Two patients had anterior temporal lobectomy and MST in posterior language cortex. One patient who had undergone a previous frontal tumour resection had only MST over the frontoparietal convexity, including frontal and parietal language areas. Both patients with MST in the posterior language cortex had postoperative language dysfunction, which had improved significantly by 9 months after surgery. The patient with MST in frontoparietal language areas had improved language functions immediately postoperatively. The two men with anterior temporal lobectomies and MST are seizure-free at 1 year follow-up and the woman with frontoparietal MST has had a > 70% reduction in seizure frequency at 1 year follow-up

Legal issues must be considered in caring for patients with epilepsy. Doctors caring for people with epilepsy may be legally involved in three primary ways: as the agent of social control, as patient advocate, and as the target of liability or malpractice suits. This article examines these factors and the implications for patients and their caregivers

We examined the contribution of the temporal neocortex to short-term memory (STM) in 15 patients with left hemisphere language dominance during intraoperative or extraoperative cortical mapping prior to left anterior temporal lobectomy. Recall errors were examined following stimulation during the acquisition, consolidation, and retrieval stages of a verbal STM task. Ten patients showed stimulation-induced recall errors, and five patients showed no significant memory errors. More patients showed errors following stimulation during consolidation than during acquisition or retrieval, possibly because of disrupted transfer of information from the temporal neocortex to the hippocampus. Patients with stimulation-induced recall errors did not differ significantly from patients without memory errors in terms of seizure, demographic, or neuropsychological variables. Patients with resection of sites showing stimulation-induced recall errors had greater postoperative decline in verbal memory than did patients with resection sparing these sites. We suggest that the left temporal neocortex contributes to verbal memory consolidation in patients with chronic epilepsy

Invasive intracranial monitoring with subdural grids has led to a greater appreciation of cortical function and the discovery of ictal onset either independently or in conjunction with deep structures. With the description of multiple subpial transections the armamentarium for surgical control of intractable seizures has been expanded. Utilizing invasive intracranial monitoring with subdural grids and strips, a large series of patients with intractable complex partial seizures originating in exquisite cortex, and in some cases additionally in deep structures, have undergone surgery. These patients would previously have been judged not to be candidates for surgical control of seizures. We will present 9-month or greater follow-up in an ongoing series of patients undergoing cortical resection and subpial transections in whom there has been a statistical improvement in control or alleviation of their seizure disorder. The report will specifically discuss outcomes as related to exquisite cortex, motor, sensory and language functions, as well as clinical results and EEG