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and so numerous are its types, Lamictal Buy that the synthetical designation of " epilepsy," only, has but little value. In some epilepsies medical treatment promises most, in others surgical ; and it is well to differen- tiate the cases of each at the outset, Cheap Lamictal doing this broadly if not specifically, always reserving, how- ever, specific distinctions before undertaking the surgical treatment of any particular case. We may first lay down this general rule: The epilepsies that most seriously impair the con- * Rend before tbe fifty-ninth annual meeting of tbe American Medlco-Psycbolosioal Association, held in Washington. D. C, XIny 12, 13, 14 and 15. 1003. 548 SPRATLING: BRAIN SURGERY IN EPILEPSY. N. Y. Med. Jons, and Phila. Med. Joubnal. serous operations of the mind are less amenable to treatment Lamictal Xr by Lamotrigine Lamictal the surgeon than the epilepsies that leave the mind most largely unaffected. There is a vast difference between fits of differ- ent types in the degree in which they affect the mind. Some blot it out in a flash, completely and instantaneously, others blot it out gradually, oth- ers impair it in various degrees without affecting its complete tiestruction at any time during the fit, while still others do not even disturb it in an appreciable degree, the latter being the case with the milder monospasms, Jacksonian in character. This being true, we first single out the epilep- sies that mostly affect the motor side of the body as promising most for surgical treatment, to the Generic Lamictal exclusion of those that invade the psychical side to the greatest degree. I may illustrate this by saying that in grand mat convulsions, in which consciousness is de- stroyed through the intensity of the " explosive discharge " or through the sudden " snapping of restraint " in the motor zones, surgical measures are far more rational than Lamictal Mg when the attacks, be- ing psychical, are silent in form, causing no com- motion in the muscular system and no change in •body posture. Operations for the possible relief of Buy Lamictal epilepsy should be confined to cases in which the attacks are of grand mal or Jacksonian type, and will sel- dom be found of any use in the petit mal or psychic types. This takes no account of partial, reflex, or other rudimentary forms of the disease, many of which are well adapted to surgical treatment, Lamictal Use being due as they are to such causes as old cicatrices, an ad- herent prepuce, foreign growths in the nose, mid- dle ear disease, and other peripheral organic con- ditions, including recent injuries to the brain in which the early repair of the damage removes the cause of the attacks. RESULTS OF BRAIN SURGERY IN 33 CASES OF EPILEPSY. The types of epilepsy in which surgical Lamictal Rashes inter- vention is oftenest a rational proceeding comprise the bulk of all the epilepsies. In 1,325 cases that have come under my observation during the past eight years, 774 were grand mal and 9 Jacksonian ; together a little over 60 per cent, of the gross number. Lamictal Lamotrigine I do not wish to be understood as stat- ing that 60 per cent., Lamictal Online or over, are Order Lamictal subjects for sur- gical treatment ; I mean that it is among 60 Buy Cheap Lamictal per cent, only that some cases will be found Rash Lamictal that sur- gerj' may benefit. Before operating in any case, the patient should be carefully watched so that the exact order of invasion, the precise manner in which the fit be- gins, the manner in which it extends, involving one group of muscles, one part of the body after the other, should be carefully observed on re- peated occasions, together with the nature, fre- quency, and recurrence of the aura; for all these constitute valuable Order Lamictal Online signs that help to guide us Buy Lamictal Online to the cerebral seat of the disease. The study of such symptoms to their full advantage demands a knowledge of cerebral localization we cannot, either as epileptologists or as surgeons, fail to acquire. We can form, in a measure, some idea of the value of brain surgery in epilepsy by noting the results in the 33 cases I present at this time. Lamictal Discontinuation All of them have been under my daily observation for periods varying from one to eight years. Five of these operations were performed at the colony in cases selected with great care. The remain- ing 28 patients were operated on prior to their ad- mission : Case i. — Male, aged twenty-nine years. Fam- ily history negative. Epilepsy began Purchase Lamictal Online at seven- teen years of age. Supposed to be caused by malaria. Trephined October, 1895, six years after the first seizure Result; no improvement. Purchase Lamictal Case 2. — Male, aged thirty-one years. Father tuberculous; otherwise family history negative. Epilepsy began at thirteen years of age. Sup- posed to be caused by trauma in head. Trephined in August, 1894. Right motor region. Operation eleven years after the onset of the epilepsy. Re- sult ; no improvement.

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