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A History of Diagnostic Investigations in Epilepsy Surgery

Published online by Cambridge University Press:  28 January 2021

Khashayar Hanjani*
Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
Mostafa Fatehi
Division of Neurosurgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
Nis Schmidt
Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
Yayha Aghakhani
Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
Gary J. Redekop
Division of Neurosurgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
Correspondence to: Khashayar Hanjani, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. Email:


Epilepsy surgery has progressed significantly in the last 150 years. Functional brain maps allowed for the localization of epileptogenic lesions based on seizure patterns, allowing surgeons like McEwan and Horsely to treat epilepsy surgically. Berger’s electroencephalogram marked the first modality directly identifying epileptic abnormalities. Penfield and Jasper collaborated, as neurosurgeon and neurologist, to use EEG for surgery. Meanwhile, Wada developed the amobarbital test, improving the protection of language and memory. Talairach and Bancaud pioneered invasive monitoring of deep brain activity with stereoelectroencephalography before the computer age made CT and MRI possible. Looking forward, AI and robotics hold promise for further improving outcomes.

Résumé :


Historique des modalités diagnostiques dans la chirurgie de l’épilepsie.

La chirurgie de l’épilepsie a progressé de manière notable au cours des 150 dernières années. La cartographie fonctionnelle du cerveau a ainsi permis la localisation de lésions épileptogènes en fonction du type de crise convulsive, ce qui a permis à des chirurgiens comme McEwan et Horsely de traiter l’épilepsie au moyen d’interventions chirurgicales. L’électroencéphalogramme de Berger a constitué la première modalité d’identification directe des anomalies épileptiques. De leur côté, Penfield et Jasper, respectivement neurochirurgien et neurologue, sont connus pour avoir collaboré dans l’utilisation de l’électroencéphalographie (EEG) lors d’interventions chirurgicales. À l’aide de l’amobarbital sodique, Wada a quant à lui développé un test grâce auquel on a pu améliorer la protection des capacités langagières et mémorielles des patients. S’appuyant sur la stéréo-électroencéphalographie, Talairach et Bancaud ont été par ailleurs les pionniers de la surveillance invasive de l’activité cérébrale profonde, et ce, avant que l’ère de l’informatique ne rende possible les examens de tomodensitométrie et d’IRM. Enfin, si l’on se tourne vers l’avenir, l’intelligence artificielle et la robotique constituent des domaines prometteurs en vue d’une amélioration des traitements offerts.

Historical Review
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Canadian Journal of Neurological Sciences Inc.

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Previous Presentations: The contents of this paper were presented in the form of an oral presentation at Vancouver General Hospital on March 11, 2020, as the winner of the Nis Schmidt History of Surgery Prize.


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