History of Epiletology

(epilepsy as a medial science throughout the ages)

The scientific study of the clinical picture of epilepsy was not one of continuous development. People knew less about epilepsy in the Middle Ages than they did during the lifetime of the Greek physician Hippocrates, who had lived more than 1500 years before.

Hippocrates

approx. 460 - 375 BC)

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 [surplus] 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 originate in the brain.

Epileptic activity is caused by surplus phlegm - Hippocrates' humoral theory. (Correct : Epileptic activity is caused by a disturbance of the electro-chemical excitatory processes in the brain).

Galen

(129 - approx. 200)

On diseased parts of the body

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!)