Epilepsy Through the Ages:

A very brief account of how we got to where we are,

and what we still need to accomplish,

with a little commentary of my own 

 

Some of this may seem hard to believe. 

As challenging as this condition can be, I’m glad I didn’t live in ancient times!

 

            By its very nature, epilepsy has been around as long as we humans have. But understanding it is a far different matter. Recorded descriptions of seizure-like activity go back as far as 2000 B.C. The Babylonians in ancient Mesopotamia were apparently the first to document a case. Written on a stone tablet, the physician-author of that time offered this description of a seizure: “His neck turning left, hands and feet are tense, and his eyes wide open, and from his mouth froth is flowing without him having any consciousness.” The predominant belief at the time was that these physical symptoms, which could appear so suddenly and dramatically, must be the result of powerful evil spirits entering the body. Wrong, but medical science remained centuries into the future. To onlookers back then, observing a seizure could be frightening. Who wants to be around evil spirits? So, we can see that the stigma and isolation surrounding epilepsy was there from the beginning. 

            The first understanding of the relationship of the brain to the body can be traced to Egypt around 1700 BC. A man with a gaping wound to his head was observed to “shudder exceedingly” when the wound was examined by touch. This led to the idea that seizures could be caused by injuries to the head. That was a step forward, rather than the popular idea at the time that seizures occurred because of angry spirits or gods.

            The ancient Greeks studied seizures and came up with the term epilambaniem, meaning “to seize, possess or attack,” because they believed it was caused by an attack from a god or demon. Epilepsy cases were usually considered to be caused by the individual somehow angering Selene, the goddess of the moon.  However, other gods or goddesses could also be displeased, who exhibited their wrath by causing seizures. An individual’s seizure symptoms were clues as to which one of the other gods had been angered. For example, if the patient made horse-like sounds, that meant the god Poseidon was angry. In mythology, Poseidon, you see, was thought to appear in the form of a horse to capture the goddess Demeter who had herself become a mare to hide from him (Yes, Poseidon was also the god of the sea and of earthquakes as well). To end the seizures, the patient was instructed to bring offerings to the god they had upset. Unfortunately, if the seizures persisted in spite of the individual’s offerings, the person was often put to death. So, we still had a long way to go. Because of the belief that it was related to the gods or the divine, epilepsy came to be known as the “sacred disease.”

Hippocrates, the famous Greek physician in the 5th century BC, tried to explain that epilepsy and seizures came from a condition of the brain, and could possibly be hereditary, or due to head trauma. He believed the affliction was no more “divine” than other diseases and considered that it could be cured, like other diseases, unless it became chronic.  Nor did he believe epilepsy was contagious. He was also one of the first physicians in history who tried to help individuals with the social stigmas that stem from epilepsy. It is unfortunate that his findings were not widely accepted. 

          The belief that epilepsy was related to the supernatural would persist for several more centuries, into the Middle Ages (roughly 400-1400). Medicine and other sciences were ridden with superstition based on religious beliefs and doctrine. Convulsions were the work of witchcraft. Exorcisms were performed.

         The Renaissance brought renewed learning. The Scientific Revolution included new discoveries in medicine, and that included a more gradual understanding of epilepsy. New causes of seizures were proposed, such as chemical particles, poisonous vapors affecting the brain, or that syphilis was the culprit. Although incorrect, the focus was now on the brain, away from superstition. By the late 16th century physicians began to consider head injuries as a cause. The Hippocratic idea that epilepsy was a brain disorder had finally gained traction in Europe and would continue through the 17th into the 18th century. William Cullen, a Scottish physician, discovered that seizures could occur partially and without the individual becoming completely unconscious. The need to hospitalize some patients with epilepsy was brought to light by the French physician Maisonneuve. Samuel Tissot, a Swiss physician, created descriptions for several different types of epilepsies, advancing the need for further study. He also dispelled the superstition that the moon caused convulsions.

            The 19th century continued to bring about more advancements in the discovery of brain function and epilepsy. Dr. Robert Bentley Todd hypothesized that seizures were caused by electrical discharges in the brain. In 1862, a London physician, John Hughlings Jackson, was hired by the National Hospital for the Relief and Cure of the Paralyzed and Epileptic. He had a personal reason for his desire to study brain function, as his wife had developed seizures after a stroke. His studies helped to define focal seizures. Jackson also gave us a concrete definition of the seizures themselves – “occasional sudden, excessive, rapid, and local discharges of gray matter.” These findings also led to further studies in neurology and brain function.

            In 1929, a psychiatrist, Hans Berger, invented and shared the technique of using the Electroencephalogram which recorded electrical activity in the brain. Although Berger was not able to use these findings with his psychiatric patients, this test could record abnormal brain waves in patients with seizures. Both the types of seizures and their location in the brain could be recorded on this device. Dr. Wilder Penfield and Dr. Herbert Jasper were able to show the benefit of using the EEG related to the surgical treatments they were performing. The EEG would continue to be the predominant diagnostic device for several decades.

            Medication treatments for epilepsy began in 1857 with potassium bromide until 1912 when phenobarbital was introduced. Many more antiepileptic drugs were debuted over the next century as well as new diagnostic procedures to detect seizures, brain activity and injury. These include the CAT scan and the MRI. The ketogenic diet was also introduced as a treatment for seizures in the 1920’s, and consisted of a diet high in fat but low in protein and carbohydrates. Some studies have shown positive effects, especially in children, but this is a very severe diet change and can be challenging to maintain. Medical devices to prevent seizures have also been developed including the VNS or Vagus Nerve Stimulator, the RNS or Responsive Neurostimulation and the DBS or Deep Brain Stimulation.

            Although the treatment for epilepsy, including medications, surgeries and devices has come a long way and continues to improve, the disease can still pose hardships and challenges of varying degrees. Further, the stigma of this disease remains. In some countries it is still illegal for people with epilepsy and seizures to get married. Until the 1970’s it was legal to deny a person with epilepsy simple access into a building in the United States. Denial of healthcare has become less of an issue over time but still continues to occur. People with epilepsy have job-related protections under the Americans with Disability Act (ADA), but certain restrictions on accommodations do exist, depending on state or local laws; for example, not being eligible for a job working with dangerous machinery or driving a vehicle. The reality is, employers for various reasons, if they know about it, are often reluctant to hire someone with epilepsy, and that makes it tougher. One source states that the unemployment rate for people with epilepsy is between 25% and 69%. The high school graduation rate is 64%, compared with an overall national average of 82%.Organizations such as the International League Against Epilepsy and the Epilepsy Foundation of America assist in finding funding for research, assessing the latest research and helping people with the disease find the latest information.

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References

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1. Highlights in the History of Epilepsy: The last 200 Years
National Library of Medicine

2. Hallmarks in the History of Epilepsy: Epilepsy in Antiquity
Elsevier, Science Direct

3. The History of Epilepsy: From Ancient Mystery to Modern Misconception
Cureus

4. Epilepsy 101, The New Patient and Family Guide to Living Well
Ruben Kuzniecky