Anatomy of handedness and the laterality of seizure onset: surgical implications of new understandings in motor control.

摘要

OBJECTIVES: This article pursues another corollary of the anatomy of handedness, a code for the laterality of motor control. The latter indicates the absence of any motor communication from the minor (right, in the vast majority of population) to the major hemisphere (left, in the vast majority of right handers). It also indicates that all communications between the two hemispheres are excitatory in nature. This arrangement prohibits initiation of seizure within the minor and its propagation to the major hemisphere, via the callosum. METHODS: A comprehensive review of the literature is undertaken regarding theoretical and technical reasons for the failure of seizure surgery in subjects undergoing the same for intractable epilepsy. RESULTS: Whereas the laterality of motor control is heavily biased towards the left hemisphere (approximately 80%), the operation is performed equally on both hemispheres. Failures of surgery in some series were substantially higher among those who had undergone operations onthe right hemisphere. Technical reasons for this are traced to the unreliability of tests commonly employed in securing laterality of seizure onset, which is the same as that of motor control. Accordingly, the failure rate of seizure surgery may equal the rate of false lateralization of the major hemisphere in these circumstances. CONCLUSION: Given the dichotomous anatomy of handedness, the most robust test for lateralizing the hemisphere of onset of seizure is that of determining the reaction times of two symmetrically located effectors, one on each side of the body. The side with the shorter reaction time will always be opposite to the major hemisphere. The difference between the two values is commensurate to the inter-hemispheric transfer time.