The risk of losing consciousness while driving a motor vehicle and the need to drive a car in today's society are opposing forces at play in determining the fitness and ability of people with epilepsy to drive. We must remember that until some 20 years ago, in Canada and in many other countries people with epilepsy were not allowed to drive. A movement by Canadian neurologists to establish guidelines which would enable people with controlled or remitted epilepsy to drive was headed by the late Dr. Francis McNaughton and by Dr. Guy Courtois. At present, legislation allowing people with controlled epilepsy to drive exists in every province or state of Canada and the United States and in many other countries. The International League Against Epilepsy, the professional society concerned with research, teaching and patient care, has a standing committee devoted to the problems of driving a motor vehicle. The Canadian League Against Epilepsy, the national branch of the International League, has carried the issues raised by driving and by the legislation governing it on the agenda of its annual meetings for the past several years. A committee headed by Dr. Guy Rémillard has compared pertinent laws and rules in different provinces with a view to establishing universally acceptable criteria and guidelines.

Computed tomography and magnetic resonance imaging enable the identification of neuronal migration disorders during life. Several specific syndromes have been identified and early diagnosis of previously unrecognized entities is now possible. We report 51 patients with imaging. Thirty-two had a single widespread cortical dysplastic lesion. Twenty-eight had focal corticectomies. From a pathological standpoint, these encompassed focal cortical dysplasia (14 cases) and forme fruste of tuberous sclerosis (10 cases). These two groups of patients were indistinguishable from the clinical and radiological standpoint. In only two was the MRI examination normal. In addition, there were 10 with bilateral perisylvian dysplasia, four with diffuse cortical dysplasia or the "double cortex" syndrome, three with hemimegalencephaly, one with megalencephaly, and one with nodular neuronal heterotopia. The electroclinical and imaging findings led to the development of specific surgical strategies for the alleviation of the intractable seizures in each of these radiologically-defined syndromes.

It is particularly fitting that at this reception of members of the Canadian Neurological and Clinical Neurophysiologists Societies at the American Academy of Neurology we should honour Dr. Herbert Jasper. He is, at the age of 90, a living legend in the neurosciences. It is a rare opportunity for the young people who have followed him to meet a pioneer of his generation, let alone somebody who continues to this day to exercise his wise counsel and his extraordinary grasp of the working of the human brain.

Herbert Jasper, like Wilder Penfield, was born in the west of the United States, and, like his friend and colleague, became a Canadian and a founder of Canadian Neuroscience.

Jasper started his career as a psychologist of physiological persuasion and studied with Lapique who is remembered for his studies on chronaxie, in Paris. He became aware of Berger’s writings on the electroencephalogram and realized early the enormous potential of being able to record the electrical activity generated by the human brain. In the 30s, two schools of epilepsy developed in North America: the medical with William Lennox in Boston, and the surgical with Wilder Penfield in Montreal.

Background: The observation that resection of structural lesions of the frontal lobe provides an effective treatment of intractable epilepsy has been made by surgeons specializing in this field for over sixty years! However, the excellent results achieved when such resections are coupled with the use of modern diagnostic and operative technologies are not fully appreciated by the modern clinician. Methods: We review the results of resection of large post traumatic frontal lesions in six patients with intractable frontal seizures. No invasive EEG recording was required pre-operatively. Results: The imaging characteristics of the underlying lesions, usually due to depressed skull fractures are illustrated. Surgical treatment rendered five patients seizure free and the sixth had over 85% improvement in seizure frequency. Conclusions: Modern imaging permits ready visualization of the post traumatic lesions with cause intractable seizures. It is important to recognize that resection of these post traumatic scars usually leads to excellent seizure control.

Medical intractability is one of the absolute indications for considering temporal lobe epilepsy surgery. This is a relative concept that has to be highly individualized. It is quite easy to determine when a patient's seizures are fully controlled. On the other hand, “continuing seizures are not necessarily a measure of intractability or disability”. A positive decision to operate would be based on some of the following factors: assurance of a firm diagnosis, seizures that are frequent and disabling, and seizures occurring in patients who are drug refractory to optimal anti-epileptic medications and dosages.

Stories abound about the medical abuses that have come to define medicine and the “pseudo”-neurosciences in the Third Reich. Well known are the Nazi program of euthanasia and the neuroscientific publications that arose from it. Nevertheless, during this widespread perversion of medical practice and science, true medical heroics persisted, even in the concentration camps. In December 1942, inmates of Camp Vapniarka began experiencing painful lower extremity muscle cramps, spastic paraparesis, and urinary incontinence. In order to reduce the cost of feeding the 1200, mostly Jewish, inmates of Camp Vapniarka and surreptitiously hasten their deaths, the Nazi-affiliated Romanian officers of the camp had begun feeding them a diet high in Lathyrus sativus. L. sativus is the neurotoxin implicated in neurolathyrism, a degenerative disease of the upper motor neurons. Dr. Arthur Kessler, one of the camp's prisoners, eventually identified the source of the epidemic. Armed with this knowledge, the inmates collectively organized to halt its spread.

Cluster headache is recognized by the International Headache Society as a primary headache disorder, consisting of seasonal and daily attacks of severe unilateral periorbital pain accompanied by autonomic symptoms. As with other primary headache disorders, intracranial lesions can rarely mimic cluster headaches, in particular if it presents in an atypical fashion. We report a patient with chronic cluster-like headache secondary to a clival based epidermoid cyst. This is the first such association reported in the literature.

A 39-year-old man with no significant past medical history and no current medications was referred with a three-year history of strictly right-sided headaches. Two to three times daily, he suffered attacks of excruciating pressure-like pain in the periorbital and frontal area on the right. These lasted between 10 and 90 minutes and occasionally woke him from sleep. They were always accompanied by numbness of the upper part of his face, increased lacrimation, rhinorrhea and ptosis on that side. Occasionally, he had nausea and vomiting as well. Since the onset of symptoms, attacks occurred almost daily and never remitted for more than four weeks. He tried methysergide, gabapentin, carbamazepine, lithium carbonate and corticosteroids without success. Later, his attacks have occasionally involved the left side.