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J Neurol Neurosurg Psychiatry 43:758-767 doi:10.1136/jnnp.43.9.758
  • Historical Commentary

Hughlings Jackson's Dr Z: the paradigm of temporal lobe epilepsy revealed

  1. David C Taylor,
  2. Susan M Marsh
  1. Human Development Research Unit, Park Hospital for Children, Headington, Oxford

      Abstract

      On 10 January 1894, a distinguished physician died in London of an overdose of chloral hydrate. The event was of vital interest to Hughlings Jackson who attended the post-mortem examination with a bevy of witnesses. He begged his colleague Walter Colman “to search the taste region of Ferrier on each half of the brain very carefully.” They were rewarded by finding “ a very small focus of softening in that region (in the uncinate gyrus) of the left half of the brain.” Jackson had thus discovered the most discrete and circumscribed lesion of the temporal lobe yet described to assoicate with the most detailed and elegant self report of psychomotor epilepsy yet published. For the physician, whom Jackson and Colman called “Dr Z” in their report in Brain2 had been Jackson's patient since 1877 and his own account of his epileptic experience had occupied six pages of Jackson's 1888 article “On a particular variety of epilepsy....”7 Jackson had himself witnessed several of Dr Z's attacks. The case enabled Jackson to argue that the complex symptomatology of the seizure was due to “reflex” effects of epileptic discharges in that area of brain. It is the paradigm of temporal lobe epilepsy.