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THE HISTORY OF EPILEPSY

Hippocrates: a conventionalized image in a Rom...Image via Wikipedia
THE
 HISTORY

OF

EPILEPSY





Hippocrates

(460 - 377)

Galen

(129 - 200)

A. of Tralleis

(525 - 600)

Avicenna

(980 - 1037)




The Middle Ages



The Renaissance



Paracelcus

(1439 - 1541)

S.A. Tissot

(1728 - 1797)

J.H. Jackson

(1935 - 1911)






When did epilepsy begin? When epilepsy recognized? What did people think about epilepsy? What famous people had epilepsy? Here is the history of epilepsy and the correct and incorrect statements that people thought about epilepsy.



EPILEPSY



The Most Important Secrets

You Must Learn

In Order To Live, Learn, and Be Happy With Epilepsy








The History of Epilepsy



Epilepsy has been on this planet as far back as time will take us. Epilepsy has existed since the world was blessed with the birth of humans and it has been recognized since the earliest medical writings. Epilepsy has attracted much attention in the medical community, since the beginning of time. Few medical conditions have attracted so much attention and generated so much debate as epilepsy.



460 - 375 B.C.

Hippocrates was a physician from the island of Cos in ancient Greece. Known as the “Father of Medicine.” The Greek physician Hippocrates wrote the first book on epilepsy, On the Sacred Disease.






 "It is thus with regard to the disease called sacred: it appears to me to be in no way more divine nor more sacred than other diseases. The brain is the cause of this affliction. When the phlegm from the brain runs down through the veins, the patient loses his speech and foams at the mouth, his hands are contracted, the eyes contorted, he becomes insensible, and in some cases, the bowels are emptied. The patient kicks with his feet. The patient must endure all these symptoms when the cold phlegm flows into the warm blood."

Correct statements:

 Epilepsy is a natural disease, not a "sacred" one.

 Seizures begin in the brain.



Incorrect statement:

Epilepsy motion is caused by surplus phlegm - Hippocrates' humoral theory.

Disagreeing with the idea that epilepsy is a curse or a visionary power, Hippocrates proves the truth: It is a brain disorder. "It is with looked upon as the disease called Sacred”. Hippocrates said, “It appears to me to be nowise more divine nor more sacred than other diseases, but has a natural cause like other affections."

The Greek physician Hippocrates wrote the first book on epilepsy, titled On the Sacred Disease, around 400 BC. Hippocrates recognized that epilepsy was a brain disorder, and he spoke out against the ideas that seizures were a curse from the gods and that people with epilepsy held the power of prophecy.

Unfortunately, false ideas die slowly in our society, and for centuries epilepsy was viewed as a curse of the gods, or worse. For example, a 1494 handbook on witch-hunting, Malleus Maleficarum, written by two Dominican friars under papal authority, said that one of the ways of identifying a witch was by the presence of seizures. This book guided a wave of persecution and torture, which caused the deaths of more than 200,000 women thought to be witches.

Misinterpretation has continued for many years. In the early 19th century, people who had critical epilepsy and people with psychiatric disorders were cared for in asylums, but the two groups were kept separated because seizures were thought to be contagious. In the early 1900s, some U.S. states had laws forbidding people with epilepsy to marry or become parents, and some states permitted sterilization.

The modern medical age of epilepsy began in the mid-1800s, under the leadership of three English neurologists: Russell Reynolds, John Hughlings Jackson, and Sir William Richard Gowers. Hughlings Jackson is meaning of a seizure as "an occasional, an excessive, and a disorderly discharge of nerve tissue on muscles is still in existence today.” Hughlings Jackson also taught others that seizures could alter consciousness, sensation, and behavior.

The past century has brought an abrupt increase of information and research about the functions of the brain and about epilepsy. Epilepsy research continues at an energetic speed, with research ranging from how microscopic particles and channels in the cell trigger seizures, to the Progress of new seizure medicines, and to a better understanding of how epilepsy affects social and intellectual development.

In 70 A.D. Gospel According to Mark (9:14-29), Jesus Christ casts out a devil from a young man with epilepsy: "Teacher, I brought you my son, who is possessed by a spirit that has robbed him of speech. Whenever it seizes him, it throws him to the ground. He foams at the mouth, gnashes his teeth, and becomes rigid. I asked your disciples to drive the spirit out, but they could not.” (NIV)



Roman medicine: Galen (129 - approx. 200):

On diseased parts of the body



Born AD 129, Pergamum, Mysia, Anatolia

died c. 216

Greek physician, writer, and philosopher: Latin Galenus

He became chief physician to the gladiators in AD 157. Later, in Rome, he became a friend of Marcus Aurelius and physician to Commodus. Galen saw anatomy as essential, based on animal experiments, described cranial nerves and heart valves, and showed that arteries carry blood, not air. However, in extending his findings to human anatomy, he was often in error.

Following Hippocratic concepts, he believed in three connected body systems—brain and nerves for sensation and thought, heart and arteries for life energy, and liver and veins for nutrition and growth—and four body fluids—blood, yellow bile, black bile, and phlegm—that needed to be in balance. Few had the skills to challenge his seductive physiological theory. He wrote about 300 works, of which about 150 survive. As they were translated, his influence spread to the Byzantine Empire, Arabia, and then Western Europe. A stimulation of interest in the 16th century led to new anatomical investigations, which caused the overthrow of his ideas when Andreas Vesalius found anatomical errors and William Harvey correctly explained blood circulation.

According to Galen there are three forms of epilepsy:

"In all forms it is the brain which is diseased; either the sickness originates in the brain itself, or it rises in sympathy into the brain from the cardiac orifice of the stomach. Seldom, however, it can have its origin in any part of the body and then rises to the head in a way, which the patient can feel.

Case description: I heard the boy say that his condition began in his lower leg and then moved up through the thigh, the groin and side of the chest above the affected thigh up to the neck and then to the head. As soon as [the condition] reached this part, he said that he was no longer aware of himself. When the doctors asked what the movement into the head was like, [another] boy said the movement upwards was like a cold breeze (aura)."

Correct statements:

• "The brain is diseased.”

• There are signs of the onset of a seizure, which only the patient is aware of: the aura. This is the first time this term is used in medical literature.

Incorrect statement:

• Epileptic activity can (primarily) originate in one part of the body and then (secondarily) affect the brain. (Correct: Every seizure begins primarily in the brain!)



Byzantine medicine: Alexandros of Tralleis (approx. 525 - 605):

12 books about medicine

"The proof that epilepsy begins in the stomach lies in the fact that a feeling of restlessness and gnawing begins in the stomach and then the patient feels the affliction approaching. As soon as the patient gets up in the morning and has emptied his bowels, he should drink an infusion of hyssop, which will do him a lot of good, as many have been healed simply by drinking this, and were only taken ill two or three times. It is forbidden to drink undiluted wine after taking a bath as nothing can set off a seizure more easily than this - and indeed undiluted wine is in general dangerous for all epileptics."

Correct statements:

• An aura (Galen) can take the form of a stomach complaint.

• Alcohol can increase the risk of having an epileptic seizure.

Incorrect statement:

• Plants or parts of plants (like hyssop) are effective cures for epileptic seizures. (Correct: There are no herbal remedies for epilepsy.)





Arab medicine: Avicenna (980-1037): Canon medicinae

Born 980, Bukhara, Iran died 1037, Hamadan Islamic philosopher and scientist.



Arabic Ibn Sina in full Abu 'Ali al-Husayn ibn 'Abd Allah ibn Sina He became physician to several sultans and also twice served as vizier. His Canon of Medicine was long a standard work in the field. He is known for his great encyclopedia of philosophy, The Book of Healing. His other writings include The Book of Salvation and The Book of Directives and Remarks. His interpretations of Aristotle influenced European Scholasticism. His system rests on a conception Of God as the necessary existent: only in God do essence, (what God is) and existence (that God is) coincides.

"Epilepsy is a disease which prevents those organs affected from using the senses, moving and walking upright and this is caused by a blockage. Usually it is a general seizure, caused by some damage, which affects the front cerebral ventricle; and it is impossible for the person affected to remain standing upright.





Correct statement:

• Epileptic seizures originate in the brain and often lead to loss of upright posture (falling) and "impairment of the senses" (e.g. twilight states or unconsciousness).

Incorrect statement:

• Seizures caused by epilepsy are caused "mechanically" by a blockage and are localized in the front cerebral ventricle. (Correct: Epileptic seizures are the result of a stimulation disturbance in the cerebral nerve cells.)







Medicine in the Middle Ages: Falling Sickness Blessing

(14th/15th century):

As convulse and bewitch are walking across the heath, they meet the Holy Virgin Mary, the Virgin Mary asks convulse and bewitch: convulse and bewitch, where are you going?'

Convulse and bewitch say: 'We are going to him and him.'



The Virgin Mary asks: 'What are you going to do there? Convulse and bewitch say

'We're going to tear flesh, drink blood and break legs.'



The Virgin Mary says: 'you must not do that: you must go where there are bare rocks, there you can tear flesh, drink blood and break legs.'

May god the father, god the son and god the Holy Ghost help us. Amen."



Correct idea:

Confidence, positively and courage are a good basis for the successful treatment of epilepsy.



Incorrect statement:

Epilepsy is a "bewitched" disease, which can only be cured with divine aid.

Correct: Epilepsy is an organic disease that can be treated using rational means of therapy.

In 1494, a handbook on witch-hunting, Malleus Maleficarum, brings a wave of persecution and torture, leading to the death of more than 200,000 women. Written by two Dominican friars under papal authority, the book identifies the presence of seizures as a characteristic of witches.





The Renaissance (approx. from 1500):

The Renaissance physician (around 1500) gradually rejects the medical beliefs of the Middle Ages, which were influenced by the Christian faith and by superstition; he begins to make tentative steps towards practicing natural "scientific" medicine. One of the most famous and influential Renaissance physicians was Paracelcus, who devoted much time to the study of the "falling sickness", epilepsy.

The painting shows the Renaissance physician fighting death and his companions-diseases (depicted as black birds) with "new weapons":

The Stag Chemist’s, Offenburg: Mural painting around 1900 using Renaissance motifs.



Correct statement

• With scientific thought symbolized by the owl

With the experience and knowledge of ancient Greek and Roman physicians (symbolized by books);



Incorrect Statement

• Natural, specially prepared substances (symbolized by the mortar and pestle);

With chemical-physical experiments (symbolized by chemical apparatus).







Medicine in the Renaissance: Paracelcus (1493 - 1541):



On ailments which rob us of our reason (1525)

"'And such falling sicknesses have five seats: One is in the brain, the second in the liver, the third in the heart, the fourth in the intestines, the fifth in the limbs. [...] And this is not only so in human beings but also in every living creature, in animals, which also fall down in the same form as in humans, and the earthquake also has the same origin as the falling sickness. We say that it is impossible to cure the root of the disease, but that it is possible to prevent the root from growing. "

Correct statements:

• Epilepsy is organic. It is not an unnatural, mystical disease.

• Animals can also have epilepsy.

It is not always possible to cure the cause ("root") of the disease, but the symptoms can be treated ("prevent the root from growing"): the principle of symptomatic therapy.



Incorrect statements:

• Epilepsy can have its seat in the liver, the heart, in the intestines or in the limbs. (Correct: Every epileptic seizure originates in the brain.)

Earthquakes are also of an epileptic nature.

(Correct: Epileptic activity is connected with the nerve cells.)





Medicine in the 18th century: Samuel Auguste A. D. Tissot (1728 - 1797):

Treatise on Epilepsy or the Falling Sickness (1771)

"In order to be in a position to cure this disease, one must first take pains to examine whether there is any sympathetic cause which supports it, and what this could be; or whether it is an idiopathic one, that is to say whether it simply stems from an over-sensitivity of the brain.



At last, valerian has fortunately become the favorite remedy of all sensible physicians. I am convinced that, if this does not have an effect, then it is because the malady is incurable."



Correct statement:

Differentiation between "idiopathic" and "sympathetic" epilepsies.

Idiopathic: Epilepsy is mainly caused by an inherent tendency to the disease.

Sympathetic (symptomatic): The epilepsy is a symptom of a primary disease (e.g. brain tumor, metabolic disturbance, cerebral scarring after injury).



Incorrect statement:

Valerian is a good remedy for epilepsy. (Correct: Valerian can have a calming effect, but does not suppress seizures.)



In 1859-1906, under the leadership of three English neurologists--John Hughlings Jackson, Russell Reynolds, and Sir William Richard Gowers--the modern medical era of epilepsy begins. In a study, Jackson defines a seizure as "an occasional, an excessive, and a disorderly discharge of nerve tissue on muscles.” He also recognizes that seizures can alter consciousness, sensation, and behavior. "The fit usually begins, it is to be observed, in that part of the face, of the arm, and oft the leg, which has the most varied uses. The fits, which begin in the hand, begin usually in the index finger and thumb; fits, which begin in the foot, begin usually in the great toe.



It may be that the order of frequency mentioned point merely to an order of frequency in liability of parts to become diseased. Parts which have the most varied uses will be represented in the central nervous system by most ganglion cells."

All of Jackson's statements are correct!

In 1904, the term "epileptologist" was first used to describe a person who specializes in epilepsy. William Spratling, the neurologist who coined the word, is regarded as North America's first epileptologist.

In 1912, two groups of chemists on their own created Phenobarbital under the name of Luminal. Phenobarbital is the oldest AED in common clinical use.



In 1920, the ketogenic diet is one of the oldest forms of treatment for epilepsy. Created in the 1920s when there were few effective treatments for epilepsy, this special diet, which is high in fat, low in protein, and has negligible amounts of carbohydrate, was created to simulate some of the metabolic effects of fasting, a state known to decrease seizures in some individuals.



In 1929, a German psychiatrist named Hans Berger announced to the world that it was possible to record electric currents generated on the brain, without opening the skull, and to illustrate them graphically onto a strip of paper. Berger named this new form of recording as the electroencephalogram (EEG).

In 1939, Discovery and clinical testing of phenytoin (PHT) by Merritt and Putnam introduced both a major new non-sedating AED and an animal model of epilepsy. For over forty years, PHT has been a first-line medication for the prevention of partial and tonic-clonic seizures and for the acute treatment of seizures and status epilepticus.



In 1953, Schindler at Geigy synthesized Carbamazepine (CBZ) in an effort to try to compete with the new introduced antipsychotic, chlorpromazine. Over the years, CBZ has gained acceptance as a first-line treatment for partial and tonic-clonic seizures.



In 1958, Ethosuximide (ESM) was introduced as an AED and has been the drug of choice for children with absence seizures who do not also have tonic-clonic or myoclonic seizures. ESM is also effective for atypical absence seizures.



In 1963, Sodium Valproate (VPA) anticonvulsant property was recognized serendipitously when it was used by Pierre Eymard as a solvent for a number of other compounds. VPA is effective over the complete range of seizures.



In 1968, The Epilepsy Foundation is a national, charitable organization, founded in 1968 as the Epilepsy Foundation of America. The only such organization devoted to the well-being of people with epilepsy, there objective is to work for children and adults affected by seizures through research, education, advocacy and service.

There national office is in Landover, MD, a suburb of Washington, D.C. More than 60 affiliated Epilepsy Foundations serve people with seizures, and their families, in hundreds of communities nationwide.

A volunteer board of directors governs their work; a distinguished board of physicians and scientists oversees the scientific and medical programs. The Foundation is a member of the National Health Council and the International Bureau for Epilepsy. The organization is supported almost entirely by private donations.

In 1970, the Veterans Administration spearheads a movement toward creating epilepsy centers, introducing a new breed of neurologists who began to specialize in the treatment and research of epilepsy.



In 1990, even in the twentieth century, some U.S. states had laws forbidding people with epilepsy to marry or become parents, and some states permitted sterilization. To establish a clear and comprehensive prohibition of discrimination based on disability, Congress passed the American’s Disability Act of 1990.

In 1993, Felbatol (felbamate) and Neurontin (gabapentin) are FDA approved. The first new epilepsy drug treatment in more than 10 years received FDA approval July 29.

In 1994, Lamictal (lamotrigine) is FDA approved. The FDA has approved Lamictal Tablets (generic: lamotrigine) as an additional therapy for partial seizures in children aged two and up. This expands the already approved use in adults with partial seizures and for the generalized seizures of Lennox-Gastaut syndrome in children.

In 1996, the FDA approves Topamax (topiramate).

In 1997, FDA approves Gabitril (Tiagabine).

In 1997, The U.S. Food and Drug Administration (FDA) approved vagus nerve stimulation in combination with seizure medication for partial epilepsy in adults.

In 1999, FDA approves Keppra (levetiracetam). The FDA approved Keppra for use in adults as a secondary treatment for epilepsy in 1999. A new study presented today at the Child Neurology Society meeting suggests that Keppra may also be effective as a first-line treatment for children who do not respond to traditional therapies.



In 2000, Trileptal (Oxcarbazepine) and Zonegran are approved by the FDA. Also in 2000, A landmark conference, "Curing Epilepsy: The Promise and the Challenge," organized by the Epilepsy Foundation of America, sets confident goals for future treatment as well as prevention and cure of epilepsy; no seizures or side effects for those with the disorder; and discovering ways to stop epilepsy caused from injury, infection, or errors of development.

There is no other disorder or disease that has given so many different names in the course of history as epilepsy. From this, we can conclude that throughout the ages people have been preoccupied with this disease. There are two main reasons for this interest:

First, epilepsy has always been a common disorder: zero, 5-1% of all the people who have been diagnosed with epilepsy.



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