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J R Soc Med. 2006 March; 99(3): 105.
PMCID: PMC1383750

Author's reply

By cerebral localization I am referring to the science of localizing normal and abnormal (lesional) function to discrete brain areas. Charcot had his share to say on this, as did others, and certainly Charcot's is the dominant voice in localization of abnormal cerebral function.1-3

Dr Richardson has rightly stated the clear benefits of lesion localization (targeted neurosurgery for abscesses, tumours and epileptic foci are fine representative examples); and I agree with the implication that lesion localization provided an impetus for the development of neurosurgery.4 My point, however, is that the hallowed status of this artful skill in the history of non-surgical neurology is undeserved. Prior to the modern era, the successful localization of a neurological lesion signalled the end of the clinical encounter in (non-surgical) neurological practice. A diagnostic exercise was thus transformed into `an end in itself'.

It is the hold of lesion localization on the culture of neurology that made it a traditionally very diagnosis-centred specialty, when what really matters is to be treatment-centred. Only in the past 20 years, as clinical localization was rendered obsolete through modern imaging, have we started to come out of the shadows.


1. Goetz CG, Bonduelle M, Gelfand T. Charcot: Constructing Neurology. London: Oxford University Press, 1995: 120-7
2. Jeannerod M. Contribution of JM Charcot to the study of motor localizations in man. Rev Neurol 1994;150: 536-42 [PubMed]
3. Gasser J. Charcot and cerebral localizations. From aphasia to amnesia. Rev Neurol 1994;150: 529-35 [PubMed]
4. Tyler KL, Malessa R. The Goltz-Ferrier debates and the triumph of cerebral localizationalist theory. Neurology 2000;55: 1015-24 [PubMed]

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