The collaboration of Francis Forster and Wilder Penfield in the management of a girl with ‘reflex epilepsy’

ABSTRACT

In the era after World War II, Francis (Frank) Forster (1912–2006) became a preeminent American neurologist and epileptologist, with international prominence in the study of reflex epilepsy. Forster’s interest in reflex epilepsy began with a chance observation of the condition, in 1946, in a four-year-old girl. When medical measures failed to control her somatosensory-evoked seizures, Forster recommended surgery, and then facilitated transfer to Canadian neurosurgeon Wilder Penfield (1891–1976) at the Montreal Neurological Institute. Forster traveled to Montreal for the child’s surgery. The surgery on February 27, 1948, proved to be curative for the child, and Forster’s interactions with Penfield and epileptologist Herbert Jasper (1906–1999) made a lasting impression. This study reviews the medical and surgical history of this case, which strongly influenced Forster’s career.

KEYWORDS:

• Francis Forster
• microgyria
• reflex epilepsy
• seizure surgery
• Wilder Penfield

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

¹ Forster used the patient’s full name in his oral history and in his autobiography, but her full name was intentionally not included here. Her first name was variously given as Anne or Ann by Forster (Forster 1977, 1983, respectively), and Anna in MNI records.

² The dialogue is quoted as Forster recalled it but reformatted and with extraneous material removed.

³ EEG spikes are epileptiform sharp transients, clearly distinguishable from the background activity, with a pointed peak and a duration of approximately 20–70 ms.

⁴ An osteoplastic craniotomy is one in which the elevated bone flap remains attached to the skull by connective tissue as it is turned away from the surgical exposure.

⁵ Baldwin and Li were part of the MNI contingent at the origin of the National Institute of Neurological Disease and Blindness, Baldwin as codirector with neurologist and fellow MNI alum Milton Shy (1919–1967), and Li as director of experimental neurosurgery (Leblanc 2023b).

⁶ After-discharges are epileptiform EEG waves produced by electrocortical stimulation.

⁷ Sharp waves are epileptiform discharges with a duration of 70–200 ms.

⁸ Focal slow waves indicate that the cortex from which they originate is dysfunctional and possibly damaged.

⁹ The face area has bilateral cortical representation, so that unilateral resection has no significant, permanent effect on facial motility.

¹⁰ Penfield was president of the American Epilepsy Society in 1942, and Forster was president in 1951 and 1952 (Goodkin 2007).

¹¹ Penfield was president of the American Neurological Association in 1951. See https://myana.org/about-ana-leadership/past-ana-presidents (accessed January 6, 2024).

¹² At the Institute of Pharmacology and Chemotherapy, Academy of Medical Sciences in Moscow, Gilman nicely summarized the group’s consensus when he wrote in the institute’s guest book: “We have come to you in friendship and you have reciprocated. May this exchange of ideas at a personal level continue and grow in number. Scientists must work in peace and prosperity for the freedom and happiness of our people, and our two great countries must strive for peace for the entire world” (National Institute of Neurological Diseases and Blindness 1960, 10).

Additional information

Funding

The authors reported there is no funding associated with the work featured in this article.