Surgical treatment of epilepsy: opportunities for research into basic mechanisms of human brain function

Numerous technological developments in neurology have increased the ability to localize structural and functional abnormalities within the human brain. Such techniques have contributed to a renewed interest in resective surgical treatment for medically refractory partial seizures. Enhanced capacity to carry out detailed in vivo and in vitro measurements of neuronal activity in patients, during the course of presurgical evaluation and following surgical resection, now offers unprecedented opportunities for invasive research into normal and abnormal human cerebral function. Electrophysiological, microanatomical, biochemical and behavioral studies can be carried out without presenting undue risk or discomfort to the patient. Such research in a clinical setting presents difficulties in experimental design for the basic neuroscientist. Problems are reduced in clinical programs where diagnostic and surgical procedures are carried out in a standardized fashion according to specific protocols. The UCLA clinical protocol for anterior temporal lobectomy, based on presurgical evaluation with stereotactically implanted depth electrodes, is particularly amenable to the integration of basic research projects. This protocol and related ongoing research projects are described.