The clinical features and subjective ictal phenomena in 270 epileptic patients with electrographic temporal lobe foci are reported. The ictal manifestations observed in 199 of these patients are described and compared with those in epileptic patients with extratemporal foci reported previously. Sixty‐four percent of the patients reported historical data of possible etiological importance, but one could be reasonably certain of the cause in only 27%. Eighty‐three percent of the patients reported auras, 80% exhibited localized motor activity, and 95% demonstrated automatic behavior. Compared to patients with extratemporal foci, the patients reported here had a higher incidence of visceral (41%), complex (52%), and olfactory‐gustatory (13%) auras and of automatic behavior. On the other hand, no ictal phenomenon was unique to patients with temporal localization. The data do not support the concept of an association between “temporal lobe epilepsy” and violence.

The authors describe the use of temporal lobectomy following careful and repeated electroencephalogram (EEG) evaluation (with implanted electrodes in otherwise unresolvable cases) in the epileptic group characterized by automatisms (psychomotor seizures) with temporal epileptiform activity complicated by EEG foci in the opposite temporal lobe or by extratemporal activity. They found that this can render a significant number of patients (between 25% and 50%) either seizure-free or with significant and useful reduction in their seizure frequency. The cure and improvement rates of cases followed up after temporal resection with or without prior study with implanted electrodes were approximately equal. However, the implanted electrodes permitted surgical treatment of certain cases which would have been rejected on the basis of evidence derived from the scalp recordings alone. Of 28 of these 34 patients with persisting EEG epileptiform activity in the postoperative period, only one had such activity in a different location in a follow-up period of 6 years. No evidence of spreading epileptic activity or appearance of "mirror foci" was seen during a follow-up period averaging 8.2 years. Seizure remission up to 15 years with eventual recurrence of the original seizure type may occur following surgical therapy. Follow-up studies of surgical epileptic treatment of less than 3 to 5 years are of doubtful value.

Fifty-five patients with intractable partial seizures whose on-medication EEGs demonstrated either predominantly focal epileptiform lesions or absence of paroxysmal activity, were studied, and the effect of withdrawing all anticonvulsive drugs on their EEGs was observed. Four types of response were encountered: (1) no effect (20%); (2) specific (focal) activation (25%); (3) complex activation (29%) with wide spread of the initial on-medication focus or appearance of additional independent epileptogenic foci; and (4) “non-specific” activation (63%), consisting of bursts of either bilaterally synchronous and frontally dominant spike and waves, triphasic waves, or sharp slow complexes, or smaller amplitude rapid and diffuse spike-and-wave complexes. This latter effect is thought to be secondary to metabolic derangements resulting from the withdrawal of neurotropic agents and not directly related to the specific epileptogenic process. No association was found between type of effect and any of the following parameters: topography of on-medication focus, duration off therapy, type of anticonvulsant used, suspected underlying etiopathology, or median age when medication was withdrawn. Furthermore no evidence could be found that the development of a “complex” or “non-specific” EEG effect carried with it a bad prognosis for surgical cure following focal cortical excision.

1. 1. In experiments carried out on cats (acute, cerveau isolé preparations) unit activity within the dorso-lateral geniculate nucleus (LGD) was analyzed following three types of stimuli: flashes of light, ipsilateral optic tract and contralateral visual cortex (g. lateralis) electrical stimulation. 2. 2. A certain percentage of LGD units was found to be activated by any one of the three different stimuli and in many instances the same unit could respond to two or to all three of them. 3. 3. Convergence of impulses upon a given LGD unit from different sources, if properly timed, could modify the final effect and the unit firing would be inhibited or, alternatively, facilitated. 4. 4. These findings extend and confirm those of previous similar studies. In view of the present, different experimental design which utilizes the callosal response as the “physiological” trigger for efferent impulses from the visual cortex to the LGD, it is possible to state that most of the observed corticifugal effects are actually the result of orthodromic phenomena. Evidence is also offered to indicate the extra-reticular nature of such cortico-geniculate mechanisms.

In this investigation psychological tests were used to study the performance of patients with various forms of epilepsy. A pilot study suggested that patients with temporal lobe epilepsy perform more poorly than patients with centrencephalic or diffuse epilepsy on a test of memory and that the reverse might be true on a test of attention. The memory and attention test were therefore administered to a larger, independent sample of epileptic patients which consisted of two groups with focal epilepsy (39 cases with temporal lobe and 18 with frontal lobe foci) and one group with nonfocal epilepsy (19 cases of whom 14 were of the centrencephalic variety). The several groups were matched by statistical means to control for differences in intelligence, age, duration of illness, seizure frequency, and amount of EEG abnormality. When analyzed in this manner, the results support the preliminary finding that the nonfocal (centrencephalic) patients perform more poorly than the focal patients on the test of attention; there were, however, no significant differences among groups on the memory test. Possible reasons for the inconsistent results on the memory test are discussed. The impairment of the nonfocal (centrencephalic) patient on the attention test is interpreted in terms of the Penfield and Jasper hypothesis of subcortical dysfunction in this disease.