THE EFFECT OF TEMPORAL LOBECTOMY UPON TWO CASES OF AN UNUSUAL FORM OF MENTAL DEFICIENCY BY

In 1898, when giving the final particulars and the necropsy findings of a case of epilepsy which fully exemplified dreamy states and automatisms, Hugh-lings Jackson (1931a) wrote that there were post-epileptic actions " of a kind which in a man fully himself would be criminal ". But another 25 years were to elapse before Penfield began his studies on brain-scars (Penfield and Erickson, 1941) which were eventually to secure for surgery a place in the treatment of epilepsy. At first the operations were restricted to those patients resistant to medical treatment in whom there was conclusive evidence of a focal scar, usually the result of a head injury. With the introduction of electrical recording devices, the field of surgery has been extended so that now the indications for operation comprise the recognition of an appropriate seizure pattern and the electroencephalographic evidence of a focal dis-charge in a patient resistant to medical treatment. The recognition of an appropriate seizure pattern is still of the utmost importance, notwithstanding the great value of abnormal electrical records. It is doubtful whether the wide variety of seizure mani-festations has ever been more accurately and more fully described than by Hughlings Jackson and also by Gowers (1892) and this applies in particular to that variety of seizure which is now often termed temporal lobe epilepsy. In recent years interest has been focused particularly on the forms of mental disorder which may arise in persons suffering from this type of epilepsy. As in the passage quoted from Hughlings Jackson's writings, these disorders may be episodic and strictly related to a fit. But in other patients it seems that the mental disorder may persist and worsen without remission, rendering the subject unable to retain his place in the community. Such deterioration may not necessarily be permanent if the discharging and apparently disorganizing focus can be detected and removed, as the following two cases exemplify