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Generations of neurologists have approached the bedside with the conviction that clinical observations not only serve the needs of patient care but can also provide important insights about the human nervous system in health and disease. With the widespread use of surgery for the treatment of the epilepsies during the last decade, epileptologists had similarly high expectations for insights from epilepsy surgery. There was the hope that the pathogenesis of various epilepsies might be explained by direct study of surgically resected human epileptogenic brain tissue. This hope was expressed at international conferences, in workshops, and in clinical conferences where surgical treatment was being planned and evaluated.1,2 It was anticipated that direct physiologic and anatomic analysis of resected human brain would provide insights into cellular mechanisms of seizure generation. Despite the problems posed by lack of suitable control tissue, the opportunity for study of resected human epileptic tissue had the immediate appeal of direct relevance to human epilepsy and thus a potential advantage over animal models. It was also hoped that molecular studies in resected brain might eventually provide a framework for classification of epileptic disorders at genetic and molecular levels. As is often the case in scientific inquiry, the insights have been more elusive than the expectations.
In this issue of Neurology, a clinical-pathologic analysis of surgically resected brain from three patients with epilepsy associated with cortical dysplasia suggests that study of surgically resected human brain tissue may indeed provide insights into abnormalities of cortical development and epileptogenesis. This series of three cases, and ongoing studies in other epilepsy centers,3 demonstrate how advances in …
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