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Depth and direct cortical recording in seizure disorders of extratemporal origin

From the Clinical Neurosciences Branch, National Institute of Neurological and Communicative Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.

This study is based on 28 patients with intractable seizures in whom exclusively extratemporal or a combination of temporal and extratemporal electrodes were chronically implanted for the localization of the epileptogenic process and possible surgical treatment. Clinical and electrographic data are briefly summarized, the indications for the use of implanted electrodes are outlined, and the number and position of the electrodes and the findings in each individual case are given. Four illustrative examples are described in greater detail. Mainly on the basis of data derived from this particular technique of investigation, surgical treatment was eventually carried out in 14 patients. It is concluded that the use of implanted electrodes in seizure disorders of probable extratemporal origin can be of real diagnostic benefit in certain specific situations. In most instances, however, this technique simply serves to demonstrate the complexity of an apparently simple case or, of greater clinical consequence, might tend to oversimplify cases that are actually very complex. Indeed, many data in this study raise some doubts about the validity of the classic concepts of "focal" epilepsy.

Dr. Ajmone Marsan's address is Clinical Neurosciences Branch, NINCDS, Bldg. 10, Room 4N262, Bethesda, MD 20014.

Received for publication December 22, 1975.

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