There is a growing pessimism represent ing the return-swing of the optimistic pendulum of ten years ago with regard to the value in results of surgical treat ment for organic epilepsy. Von Berg mann and McCosh, among recent writers, unite in a demand for greater conserva tism. Mason, quoted by Gray, tabulates 44 cases treated surgically, with two re coveries, or about 4 per cent. This table is capable of another interpreta tion, however, which is decidedly more favorable from the fact that in more than half the cases in which the time of ob servation after operation is said to have been "insufficient to confirm the claim of cure," further lapse of time may serve to establish the claim at least in some of these cases.
Reports of seventy operations for epi lepsy collected more or less at random from current literature, of which, at the expiration of three years or longer, 4.03 per cent. were cured. E. G. Mason (Med. News, Mar. 21, '9G).
Analysis of 70 operative cases of epi lepsy. Conclusions as regards prognosis: (a) A certain small percentage of the cases will be cured. (b) A certain larger percentage will be improved. (c) An even larger percentage 'will not he im proved at all. (d) An operation upon almost any case will produce a tempo rary cessation of fits. Mason (Med. News. Mar. 21, '96).
The consensus of opinion among neu rologists and surgeons at present seems to be that operations are indicated only in recent. cases, within one year after the injury, in cases in which general epi lepsy has followed, and in cases in which the attacks are of a purely focal or Jack sonian type, especially if an injury has preceded and corresponds to the motor centre presiding over the muscles which are the seat of convulsive movements. The reason that the operation does not give permanent relief in cases of long duration is explained by the theory that the epileptic habit has become estab lished, or that cortical degeneration has taken place which relief of the super ficial irritation does not remove. G. E. Brewer (Med. News, Dec. 23, '99).
Almost all cases of epilepsy which come within the etiological subtype flex" demand surgical measures of relief, the removal of the peripheral course re quiring, in most instances, the knife.
Phimosis, cervical stenosis, carious teeth, nerve-cicatrices, diseases of the bones, eye-strain, and ovarian disease are all conditions for which the knife or other surgical or mechanical agents are indi cated.
Castration performed in twenty-two cases, twenty of them in males, with favorable results. Everett Flood (Med. Record, May 23, '96).
Case of primary dysmenorrhoea with epilepsy, in a girl 17 years of age, who was cured after dilatation of the cervix uteri. Braithwaite (Lancet, July 31, '97).
In all cases of epilepsy, when such con ditions or any one of them exists, either coincidently, alone, or as the presumable cause, they should be appropriately re lieved. It will not always, nor indeed often, cure epilepsy; but such conditions undoubtedly aggravate the epileptic tendency, and should be eliminated. I have never yet seen a case of epilepsy cured or even benefited permanently by operations upon the eye-muscles or by re moval of the ovaries, and I have seen scores of patients upon whom such oper ations have been done.
The performance of normal ovari otomy for epilepsy is to be regarded as hardly better than malpractice. Lusk (Boston Med. and burg. Jour., Oct. 15, '91).
Such operations should be done, though with discrimination and always with the frank acknowledgment to the patient of the uncertainty of results.
Resection of the cervical sympathetic in 45 epileptics. There was no trophic disturbances nor was any influence noticeable on the general or mental con dition of the patient. Of 19 patients observed for a considerable length of time, 55 per cent. were cured, 23 per cent. improved, and 15 per cent. were not improved. The operation is not indicated in cases with either mania or dementia; there are already organic changes in the brain, which no operation can help. In recent uncomplicated cases there is every reason to look for a satisfactory result. Jonnesco (Centralb. f. Chic., Feb. 11, '99).