A Historical Review Of Epilepsy Surgery And Its Application In Children

The history of epilepsy surgery dates back to the late Nineteenth Century, with the first epilepsy surgery procedure performed by Victor Horsley in 1886. Horsley's initial surgery, as well as his subsequent procedures on epilepsy patients, were a culmination of the collaboration between clinical physiologists and surgeons at the National Hospital for the Paralyzed and Epileptic in Queen Square, London. Around the same time, Fedor Krause started a school of epilepsy surgery in Germany focusing on cortical stimulation and motor cortex mapping. The International League Against Epilepsy, which was established in 1909, brought together these seminal figures as well as the surgeons William Macewen and Harvey Cushing. Following the First World War, while epilepsy surgery techniques were being propagated through this network, the electroencephalography (EEG) was invented and was used for intraoperative recordings, localizing epileptogenic cortical areas, and guiding resections. One of the EEG's champions, the German neurologist and neurosurgeon Otfrid Foerster, inspired Wilder Penfield's work in cortical stimulation techniques beginning in 1928. Penfield would go on to establish the Montreal Neurological Institute (MNI), which became a pioneer center in the electrophysiology-guided treatment of the epilepsy patient. Although pediatric patients were involved in these epilepsy surgery milestones, the first surgical series to focus on this specific patient population was completed by Murray A. Falconer in London in 1970, with other significant series' published by Sidney Goldring in St. Louis between 1978 and 1987. The first International Pediatric Epilepsy Surgery Symposium took place in 1989, with meetings and workshops continuing to be held regularly to establish guidelines and recommendations for epilepsy surgery in the pediatric population. The history of epilepsy surgery, which is deeply intertwined with the history of modern neurosurgery, encompasses the early foundations of pediatric epilepsy surgery, and this specialty continues to be refined today.