Blog #21: Dr. Paul Crandall and Surgical Treatment of Epilepsy

(This blog was originally posted on March 31, 2012)

                    
 

            Surgery on the skull and brain has been done since prehistoric times in Europe and by the Incas in Peru, among other populations. Trephination, a procedure of boring through the skull, is known to have been occasionally successful since evidence of healing has been found in these prehistoric skulls. Religious rites and attempts to relieve headaches are presumably the reason for the trephination. Was epilepsy cure a goal of these primitive procedures?

            Brain surgeries performed to treat epilepsy started in the 19^th century. The procedures in the pre-antibiotic era were fraught with infection-complications usually resulting in death. A 1930 paper by Cutter (1) reviews an 1828 manuscript by Dr. Benjamin W. Dudley. He was a frontier Kentucky doctor who reported on five cases of traumatic (injury-caused) epilepsy. Remarkably, all five survived and three were apparently “cured” of epilepsy.

            In the 21^st century, between 15-20 percent of people with epilepsy have inadequate control of their seizures with anti-seizure medications. Their daily lives are severely impaired. They are potential candidates for brain surgeries to remove the abnormal cells causing their seizures. Those abnormal areas in the brain’s cortex can be removed only if they are in an area of the brain amenable to removal without causing undue loss of important brain functions.

Prominent in advancing the technology to accomplish these successful surgeries was Los Angeles neurosurgeon Paul Crandall. He died March 30, 2012 in Santa Monica, CA at age 89. His obituary written by Thomas H. Maugh II appeared in the Los Angeles Times on March 30, 2012.

Chief of Neurosurgery at UCLA, Dr. Crandall was a leader in epilepsy surgery. He worked near my own medical center in southern California. He worked closely on patients with epilepsy with then Chief of Neurology at UCLA, Dr. Richard Walter. They implanted electrodes in the brains of patients and monitored their EEGs for extended periods in the 1960s. This technique was perfected by eventually adding telemetry that was borrowed from NASA’s early space technology. This enabled identification and localization of the site where the seizures originated in the brain. Video recordings documented the seizure activity in patients who demonstrated altered mental and physical aberrations that correlated with their brain EEGs. This eventually allowed the focus of the abnormal brain neurons (cells) in the cortex on the brain’s surface to be identified. Surgical removal of these cells usually decreased or even totally eliminated the seizures. These techniques are now used in surgical epilepsy centers world-wide. Dr. Crandall’s prodigious contributions in the field of epilepsy advanced the abilities of neurologists and neurosurgeons to improve the quality of their patients’ lives.

(1) Cutter, JS. Benjamin W. Dudley and the surgical relief of traumatic epilepsy. Internat. Abstr. Surg. 1930; 50:189-194.

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. Conner’s Little “Dings” is his first novel.