Penfield, focal microgyria, and epilepsy

Richard Leblanc MD, FRCSC
View More View Less
  • Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Wilder Penfield (1891–1976) is widely regarded as a dominant figure in 20th century neurobiology for his singular contributions to the structure-function relationship of the brain, his discovery of the language function of the supplementary motor area, the discovery (with Herbert Jasper and Brenda Milner) of the anatomy of recall, and his pioneering work in the surgical treatment of focal epilepsy. But another of his significant discoveries has escaped notice: the recognition that focal microgyria can generate epileptic seizures, and that these can be treated surgically. Penfield discussed the case of the patient through which this discovery was made during his Shattuck Lecture to the Massachusetts Medical Society in 1939. As Penfield gave only a fragmentary account of this case, the patient's chart was retrieved from the Montreal Neurological Institute archives, and his operative note and brain map, intraoperative photographs, and the histopathological and cytological examinations of the resected specimen were reviewed. Based on these primary sources, this paper provides a complete, detailed account of the first case in which microgyria was recognized as a cause of focal epilepsy, which was successfully treated surgically.

ABBREVIATIONS ECoG = electrocorticography; EEG = electroencephalography; MCC = meningocerebral cicatrix; MNI = Montreal Neurological Institute; PEG = pneumoencephalography.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Richard Leblanc: Montreal Neurological Institute, Montreal, QC, Canada. richard.leblanc@mcgill.ca.

INCLUDE WHEN CITING Published online March 19, 2021; DOI: 10.3171/2020.9.JNS202900.

Disclosures The author reports no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Leblanc R. Radical Treatment. Wilder Penfield's Life in Neuroscience. McGill-Queen's University Press; 2020.

  • 2

    Penfield W. Oligodendroglia and its relation to classical neuroglia. Brain. 1924;47:430452.

  • 3

    del Rio Hortega P, Penfield W. Cerebral cicatrix: the reaction of neuroglia and microglia to brain wounds. Bull Johns Hopkins Hosp. 1927;41:278303.

    • Search Google Scholar
    • Export Citation
  • 4

    Foerster O, Penfield W. The structural basis of traumatic epilepsy and results of radical operation. Brain. 1930;1930(53):99119.

  • 5

    Penfield W. Epilepsy and surgical therapy. Arch Neurol Psychiatry. 1936;36(3):449484.

  • 6

    Jasper HW, Penfield W. Electroencephalograms in post-traumatic epilepsy. Am J Psychiat. 1943;100(3):365377.

  • 7

    Penfield W. The epilepsies: with a note on radical therapy. N Engl J Med. 1939;221(6):209218.

  • 8

    Humphreys SP. Study of the Vascular and Cytological Changes in the Cerebral Cicatrix. Master's thesis. McGill University; 1939.

  • 9

    Penfield W, Humphreys S. Epileptic lesions of the brain. Arch Neurol Psychiatry. 1940;43:240262.

  • 10

    Penfield W. The evidence for a cerebral vascular mechanism in epilepsy. Ann Intern Med. 1933;7:303310.

  • 11

    Leblanc R. Wilder Penfield and the vascular hypothesis of focal epilepsy. J Neurosurg. 2019;131(6):19471953.

  • 12

    Penfield W. A technique for demonstrating the perivascular nerves of the pia mater and central nervous system. Am J Pathol. 1935;11(6):10071010.

    • Search Google Scholar
    • Export Citation
  • 13

    Bodian D. The staining of paraffin sections of nervous tissues with activated protargol. The role of fixatives. Anat Rec. 1937;69:153.

  • 14

    Leblanc R. The white paper: Wilder Penfield, the stream of consciousness, and the physiology of mind. J Hist Neurol Sci. 2019;28:416436.

    • Search Google Scholar
    • Export Citation
  • 15

    Penfield WG. Alterations of the Golgi apparatus in nerve cells. Brain. 1920;43:290305.

  • 16

    Penfield WG. The Golgi apparatus and its relationship to Holmgren's trophospongium in nerve cells. Comparison during retispersion. Anat Rec. 1921;22(1):5680.

    • Search Google Scholar
    • Export Citation
  • 17

    Penfield W. A method of staining oligodendroglia and microglia (combined method). Am J Pathol. 1928;4(2):153157.

  • 18

    Penfield W. Development and structure of neuroglia and microglia. Trans Am Neurol Assoc. 1927;53:33.

  • 19

    Penfield W. Principles of the pathology of neurosurgery. In: Nelson's Loose-Leaf Surgery. Vol. 2.Thomas Nelson and Sons; 1927:303347.

    • Search Google Scholar
    • Export Citation
  • 20

    Penfield W. Neuroglia and microglia: the interstitial tissue of the central nervous system. In Cowdry EV, ed. Special Cytology. Vol2 (section 30). Paul B Hoeber; 1928:10321068.

    • Search Google Scholar
    • Export Citation
  • 21

    Penfield W. Neuropathology of the brain. In: Cowdry EV, ed. The Problem of Mental Disorder. McGraw-Hill; 1934:178183.

  • 22

    Penfield W, Cone WV. Neuroglia and microglia (the metallic methods). In: McClung CE, ed. Handbook of Microscopical Technique. Paul B Hoeber; 1928:359388.

    • Search Google Scholar
    • Export Citation
  • 23

    Penfield W. The encapsulated tumours of the nervous system: meningeal fibroblastoma, perineural fibroblastoma, and neurofibromata of von Recklinghausen. Surg Gynecol Obstet. 1927;45:178188.

    • Search Google Scholar
    • Export Citation
  • 24

    Penfield W. Tumors of the sheaths of the nervous system. Arch Neurol Psychiatry. 1932;27:12981309.

  • 25

    Penfield W, Young AW. The nature of von Recklinghausen's disease and the tumors associated with it. Arch Neurol Psychiatry. 1930;32:320344.

    • Search Google Scholar
    • Export Citation
  • 26

    Penfield W. The classification of gliomas and neuroglia cell types. Arch Neurol Psychiatry. 1931;26:745753.

  • 27

    Penfield W. A paper on classification of brain tumors and its practical application. BMJ. 1931;1:337342.

  • 28

    Penfield W, ed. Cytology and Cellular Pathology of the Nervous System. Paul B Hoeber; 1932:423479.

  • 29

    Penfield W. Tumors of the sheaths of the nervous system. In: Penfield W, ed. Cytology and Cellular Pathology of the Nervous System. Vol. 3. Paul B Hoeber; 1932:955990.

    • Search Google Scholar
    • Export Citation
  • 30

    Penfield W. Neuroglia: normal and pathological. In: Penfield W, ed. Cytology and Cellular Pathology of the Nervous System. Vol. 2. Paul B Hoeber; 1932:423479.

    • Search Google Scholar
    • Export Citation
  • 31

    Penfield W, Jasper H. Epilepsy and the Functional Anatomy of The Human Brain. Little, Brown & Co; 1954.

  • 32

    Penfield W, Keith HM. Focal epileptogenic lesions of birth and infancy. Am J Dis Child. 1940;59:718738.

  • 33

    Crome L. Microgyria. J Pathol Bacteriol. 1952;64:479495.

  • 34

    Jansen AC, Robitaille Y, Honavar M, . The histopathology of polymicrogyria: a series of 71 brain autopsy studies. Dev Med Child Neurol. 2016;58(1):3948.

    • Search Google Scholar
    • Export Citation
  • 35

    Mattia D, Olivier A, Avoli M. Seizure-like discharges recorded in human dysplastic neocortex maintained in vitro. Neurology. 1995;45(7):13911395.

    • Search Google Scholar
    • Export Citation
  • 36

    Shain C, Ramgopal S, Fallil Z, . Polymicrogyria-associated epilepsy: a multicenter phenotypic study from the Epilepsy Phenome/Genome Project. Epilepsia. 2013;54(8):13681375.

    • Search Google Scholar
    • Export Citation
  • 37

    Penfield W, Erickson TC. Epilepsy and Cerebral Localization. Charles C Thomas; 1941.

  • 38

    Penfield W, Paine K. Results of surgical therapy for focal epileptic seizures. Can Med Assoc J. 1955;73(7):515531.

  • 39

    Stent GS. Prematurity and uniqueness in scientific discovery. Sci Am. 1972;227(6):8493.

  • 40

    Leventer RJ, Jansen A, Pilz DT, . Clinical and imaging heterogeneity of polymicrogyria: a study of 328 patients. Brain. 2010;133(Pt 5):14151427.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 405 405 404
Full Text Views 66 66 66
PDF Downloads 23 23 23
EPUB Downloads 0 0 0