A dialogue with historical concepts of epilepsy from the Babylonians to Hughlings Jackson: Persistent beliefs

The evolution of the concepts of seizures and epilepsy: What’s in a name?

“…His explanation of sympathetic epilepsy came from his observations from patients who reported symptoms such as palpitations, abdominal sensations, numbness or tingling prior to or as the initial symptoms of their epileptic attack . *, * It has been said that he introduced the concept of an aura (Greek, meaning “breeze”) into medical terminology, when he referred to a patient who described the initial symptoms of his attack as a sensation of a cold breeze moving upward from his legs to his head . *…”

“…The brain was divided into three levels: He termed lowest level fits “pontobulbar fits” (or brainstem seizures) and represented rough and simple movements; middle level fits from the sensorimotor cortex “epileptiform seizures” and represented complex movements of all parts of the body; and highest level fits from the frontal lobes or the organ of the mind “epileptic seizures.” He discussed how seizures marched from one part of the body to other parts (Jacksonian epilepsy), what we may now call focal aware motor seizures. Jackson also elaborated on seizures starting with a dreamlike state and the “uncinate group of fits,” * today called a focal aware/impaired awareness cognitive or sensory seizure.…”

“…*, * Charles Le Pois (1563‐1636) refuted the traditional theory of idiopathic and sympathetic epilepsy and proposed that all epilepsies originated in the brain, from a superfluity of serum in the head that flows into the roots of nerves to fill and distend them, causing various motions of the body or affecting the senses . *, *, He based his argument partly on anatomical findings, which he observed in his postmortem examinations. The lack of ventricular obstruction in most cases suggested that an irritation of the brain or its membranes is what caused seizures .…”

“…Thomas Willis (1621‐1675) came up with the idea that animal spirits released vitriolic chemical particles into the blood, which spill into the brain and spinal cord, irritating the nerves and making the muscles explode . * Giorgio Baglivi (1668‐1707) developed a mechanical theory and wrote about disturbed elastic equilibrium of fibers in the dura mater as the cause of seizures . *, * Toward the end of the 17th century, Stahl (1660‐1734) reportedly opposed these mechanical theories and viewed the epileptic attack as a reaction of the soul.…”

“…This seemed to him to be a case of reflex action, and he concluded that epileptiform convulsions might be caused by slight irritation of certain nerves and suggested that blockade of the reflex arc through application of ligatures or sectioning of nerves be used as treatment . *, *, * Astly Cooper's (1768‐1841) animal experiments and Friedrich Gustav Jakob Henle (1809‐1885) determined a connection between loss of consciousness, convulsions, and change in blood supply to the brain. Another theory was that convulsions in animals were due to changes in the molecular state of the brain through malnutrition and poisoning .…”