Naturally, the term “temporal lobe epilepsy” associates to things like language and spirituality. But like so many things, the hidden is of great interest. In this case, on the side facing in, normally out of sight, lies the hippocampus. I did not know until reading that early anatomists debated: seahorse? silkworm? I’ve always been partial to seahorse males, being such attentive dads, but I have to agree, it looks more wormlike, unless you fuss with it.
The hippocampus is central to the process of forming new memories. A very enthusiastic temporal lobectomy can take out the hippocampus. For the archetypal if extreme case, read about “HM’s brain” http://en.wikipedia.org/wiki/Henry_Molaison. As it turns out HM’s brain was also studied at the Martinos Center, our favorite research facility on the planet, before heading off to Calif where it is said to have been misplaced. That funny story triggered sharp inhalation when we realized the medical kinship of HM and KZ.
The hippocampus talks to the rest of the brain through the fornix. The apostle Paul warns against fornication,but as I tell my Sunday school students, that only means standing under an arch (fornix). Ok, and prostituting yourself. Especially in the temple of Aphrodite. It stands to reason that removal of or damage to this structure would be de-fornication, which would have the same end effect as removing the hippocampus.
One galling thing I learned in Boston was that there is something about how the hippocampus is constructed that makes it prone to generate seizures. In addition, apparently repeated seizures can damage the hippocampus over time, making it more epileptogenic, forming what I suppose to be a positive feedback loop. This might seem to lead to horrible choice, but the standard of medical care to maximize probable effect is resection; though not on both sides like HM.
The gift from the Spokane neurologist for several hellish days of worsening health and extremely well-instrumented convulsions was making plausible that the source of seizures was in a different vicinity than presumed.
The gift from the scientists at Martinos Center was magnificent 7-Tesla MRI images revealing at high resolution the plausibility of removing a lesion unwelcome in that neighborhood, while at the same time, as they say “sparing the hippocampus”.
The gift from the brilliant MGH neurosurgeon was the reasoning and confidence and consummate skill to plan and execute a very delicate surgery.
Dr Sunshine has not made the slightest, even microscopic dent in the question of: These things that have happened – what does it all mean?”, but simply recalls the Mary Chapin Carpenter lyric “life is a gift from the great Unknown, and your job is to receive it”.