Epilepsy surgery developed following the clinical and experimental demonstration of the existence of the primary motor cortex in animals and humans. The first
epilepsy surgery procedures were mainly performed to treat focal motor (Jacksonian)
epilepsy, as the seizure semiology precisely pointed to the contralateral motor cortex (epileptogenic zone), guiding the surgical removal of the visible lesion found in that region. However, mainly in the absence of any visible alteration of brain tissue, the removal of the portion of the cortex supposed to be responsible for the
seizures carried the risk of injuring healthy areas of the brain, often resulting in permanent neurological deficits. In 1891, the prominent Italian neurologist Camillo Negro (1861-1927) described a new technique to treat
focal epilepsy using galvanic electrical stimulation of the motor cortex to induce selective cortical destruction. The procedure of "cortical electrolysis", initially performed by prof. Antonio Carle (1854-1927), chief surgeon at the Mauriziano Hospital of Turin, aimed at avoiding the risk of
hemorrhage and neurological deficits due to the resective
surgical procedures, without compromising asepsis. Camillo Negro deserves to be credited as the first to have envisioned a non-resective surgical approach to the treatment of
epilepsy, which in its conceptual basis appears nowadays as extraordinarily modern and pioneering. Recent
neurosurgical procedures, such as stereoelectroencephalography-guided radiofrequency
thermocoagulation and MRI-guided
laser-induced interstitial thermal ablation, although based on different technologies, share the same rationale, using minimally invasive
epilepsy surgery to reduce tissue disruption and thus morbidity.