26/1/2018 Wilder Penfield redrew the map of the brain — by opening the heads of living patients - Vox

Wilder Penfield redrew the map of the brain — by opening

the heads of living patients
The Canadian neurosurgeon pioneered a dramatic new approach to treating epilepsy.
By Brian Resnick @B_resnick brian@vox.com Jan 26, 2018, 12:00am EST

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McGill University

Even in 2018, Wilder Penfield’s approach to treating epilepsy seems like something out of a
science fiction movie. Penfield — the celebrated Canadian-American neurosurgeon whose
127th birthday is celebrated today in a Google Doodle — pioneered the technique of
removing a portion of the skull while a patient was still awake.

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26/1/2018 Wilder Penfield redrew the map of the brain — by opening the heads of living patients - Vox

Penfield developed the method, called the “Montreal Procedure,” in the 1930s. It helped
him pinpoint the source of the seizure in the brain so he could remove it, and relieve
patients of debilitating attacks.

But his work in epilepsy also increased our understanding of the architecture of the brain,
mapping how its folds and areas relate to sensations in the body.

Penfield’s surgeries helped epilepsy patients

Descriptions of Penfield’s Montreal Procedure are an odd thing to behold. Patients stay
calm and awake while the surgeon literally electrocutes their brain.

Keeping the patients awake was crucial to the success of the procedure. Often in epilepsy,
seizures originate from one scarred or damaged region of brain tissue. The brain surgeon’s
goal is to identify that tissue while protecting healthy parts.

With the skull open and the brain exposed, Penfield would probe the brain’s surface with a
small electrode. If he touched an area of the brain that related to feeling in the fingers,
patients would report numbness in their fingers. Prodding different areas of the brain with
small electrical impulses could get patients to suddenly retrieve memories, see flashes of
light, or smell an odor. The electrode would essentially turn on, or off, the brain circuitry
involved in those sensations and perceptions.

People with epilepsy often get “auras” — an odd, specific sensation (a smell, or taste, or
thought) before a seizure. If Penfield found the area of the brain that produced the aura, he
could remove it, which then greatly reduced the risk of seizures in patients.

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26/1/2018 Wilder Penfield redrew the map of the brain — by opening the heads of living patients - Vox

Penfield could do this while patients were awake because, ironically, the brain itself has no
pain receptors. And local anesthesia allowed him to remove part of the skull without
causing much pain.

In treating epilepsy, Penfield sketched a new map of the brain

The Montreal Procedure helped many deal with the debilitating effects of epilepsy, but it
also opened up a whole new avenue of understanding how the brain works. Since the
electrical impulses would temporarily turn on, or off, a function of the brain, by slowly,
meticulously, prodding the brains of his patients, Penfield was able to develop a map of
brain function.

Here’s a photograph from a 1937 Penfield report — it’d not for the extremely faint of heart.

American Neurological Association

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26/1/2018 Wilder Penfield redrew the map of the brain — by opening the heads of living patients - Vox

Each number in the image corresponds to a particular brain function and sensation
Penfield mapped. No. 18 corresponds to “Slight twitching of arm and hand like a shock, and
felt as if he wanted to move them,” according to the report. At No. 8, the patient “felt
sensation of movement in the thumb,” but it didn’t actually move. At No. 13, the patient felt
“numbness all down the right leg.”

This was the first time areas relating to speech were mapped, McGill University, which
employed him, explains on its website.

In some instances when Penfield prodded a person’s brain, they would suddenly
experience a detailed personal memory. This was among the first evidence to suggest that
there are physical structures for memory in the brain. One of Penfield’s patients, when
prodded with an electrode, responded, “I hear voices. It is late at night, around the carnival
somewhere — some sort of traveling circus. I just saw lots of big wagons that they use to
haul animals in.”

Penfield and his colleagues used this brain map to develop a homunculus, a cartoon
drawing of a human body, sized proportionally to the amount of brain space devoted to
each body part.

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26/1/2018 Wilder Penfield redrew the map of the brain — by opening the heads of living patients - Vox

Sensory and motor homunculus models at the Natural History Museum, London. | Dr. Joe Kiff /Wikipedia

As the homunculus shows, we use a lot of our brainpower for dexterity (see the huge
hands), speech (see the giant lips and tongue), smell, and sight. And we don’t have a whole
lot of mental hardware devoted to our chests.

Penfield’s explorations of the brain helped scientists target the malfunctions that led to
speech disorders and problems with memory. And the Montreal Neurological Institute,
which Penfield co-founded at McGill, became a premier surgical treatment center for
epilepsy.

He’s also made an impression on popular culture. Science fiction author Philip K Dick
named a device to control emotions of people the “Penfield mood organ.”

Penfield was borne in Spokane, Washington, but did most of his groundbreaking work at
McGill in Canada, where he’s celebrated as a national hero. In 1934, he gained Canadian
citizenship, and he later became known as “the greatest living Canadian.” He was
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immortalized in a 60-second Canadian television spot that depicted one of his patients,
mid-surgery, declaring, “I smell burnt toast!” during the procedure. Hence the toast in
today’s Google Doodle.

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