Emergence of temporal lobe surgery for epilepsy

In 1888, Hughlings Jackson(1) reported a large series of patients from Lond on, England, with a variety of epilepsy... in which... "dream state" is a s triking symptom.... There is not always loss, but there is, I believe, alwa ys, at least defect, of consciousness... [and in some cases] there are exce edingly complex and very purposive-seeming actions during continuing uncons ciousness. Two of these patients later came to autopsy.(1,2) In one, a woman with epil epsy manifested as "a crude sensation of smell and a dreamy state" had a "t umour of the right temporo-splenoidal lobe," The other patient, known as "Z ," was a "medical man" who had his onset of seizures at age 20 years. His a ttacks were characterized as a feeling of "reminiscence" (ie, deja vu), "dr eamy state" with altered consciousness, and automatisms. With at least some of his seizures there were certain movements of the mout h and tongue, tasting movements.... Ferrier found that certain movements of the lips, tongue and cheek-pouches follow on artificial excitation of a ce rtain region of monkey's cortex.... I begged Dr. Coleman to call on me befo re he went to make the necropsy on Z, in order to ask him to search the tas te region of Ferrier..,. Dr. Coleman found a very small focus of softening in that region tin the uncinate gyrus) of the left half of the brain.(2)