Anatomical rationale of ablative surgery for temporal lobe seizures and dyscontrol: suggested stereo-chemode...

Anatomical data now strongly suggest that the common factor in curative ablative operations for the commonest (i.e. ammonshorn-sclerosis) form of temporal-lobe epilepsy is the cutting of the ipsilateral temporoammonic perforant path's "nozzle" where it leaves the entorhinal cortex to "spray" along the length of the ammonshorn. This substantially deafferences ipsilateral dentate granule-cells and hence the unsclerosed pyramidal neurons notably in "resistant sector" CA2, which are probably the source of the seizures. Stereo-chemoding of long-lasting (experimentally tested) chelates along the zone of peculiarly zinc-rich synapses of the mossy fibre system should block the commissural as well as the ipsilateral inputs to these residual neurons, to give higher percentage cures, and could probably be performed bilaterally (where indicated, in adults) without endangering memory function.