Ablation of Abnormal Cortex in Cerebral Palsy

Cerebral palsy may be defined, in a broad sense, as loss of function due to brain injury. Such injury may affect motor centres producing spastic paralysis of an arm or leg, but it may also affect other areas of the brain and thus cripple other functions than those of movement of the arm and leg. Hemispherectomy has been proposed recently as a method of treatment of infantile hemiplegia by Krynauw (1950) followed by Cairns (1951). The claim made is (1) that cerebral seizures may be stopped, (2) the mental state improved, and (3) motor function facilitated because of a lessening of spas-ticity in the paretic limbs. In the 12 cases of severe hemiplegia reported by Krynauw this very radical procedure was apparently well justified. The question to be decided is whether less radical ablations may not be preferable. The results reported for these hemispherectomies illustrate the truth of the thesis, to which I have subscribed for some time, that abnormal cortex, incapable of useful service, does, in some cases, exert a noxious influence upon the rest of the brain which miht otherwise function normally Let us examine tis thesis under the headings of epilepsy, mental retarda-tion, and spasticity. Epilepsy For some years we have been in the habit of excising abnormal cerebral cortex in the treatment of focal epilepsy. To obtain good results wide excision is often necessary but in the great majority of cases there is normal as well as abnormal cortex in that hemisphere. It seems reasonable that the bad should be sacrificed and the good spared for future useful function. In the treatment of epilepsy, periods of five to 10 years should be allowed to elapse before a summary and conclusion is made of a series of adequate size. We have in the past made three follow-up studies of the results of surgical ablation of focal atrophic epileptogenic lesions of the cortex