epilepsy history and terminology

1. DR MOHAMMAD A.S. KAMIL
CONSULTANT NEUROLOGIST
NEUROSCIENCES HOSPITAL

2. among the myriad of
human
afflictions,perhaps
none has
terrified,amazed and
inspired more than
epilepsy.

3.  One of every ten people will have at least one
epileptic seizure during a normal life span, and a
third of these will develop epilepsy.
 Worldwide, epilepsy affects 50 million people.
 According to a World Health Organization
(WHO) survey, epilepsy accounts for 1% of the
global burden of disease, a figure equivalent to
breast cancer in women and lung cancer in
men.
 80 to 90 percent of epileptics in the developing
world never receive treatment.

4.  The frequency of epilepsy is slightly higher in lower socio-
economic classes.
 The incidence of seizures is age dependent, with the
highest rates in the first year of life and a second peak in
late life.
 About 40% of patients develop epilepsy below the age
of 16 years of age and about 20% over the age of 65
years.
 the prognosis is generally good, and within 5 years of the
onset of seizures 50–60% of patients will have entered
long remission.
 However, in about 20% of cases, epilepsy, once
developed, never remits.
 Standardized mortality rates are also 2–3 times higher in
patients with epilepsy than in others in the population.
 The excess mortality is caused largely by the underlying
cause of the epilepsy.

6.  An epileptic seizure is ‘‘a transient occurrence of
signs and/or symptoms due to abnormal excessive
or synchronous neuronal activity in the brain’’ .
 Acute symptomatic seizures, sometimes called
provoked seizures, occur in the setting of acute
medical and neurological illnesses in people with no
prior history of seizures . typically occur within the
first 1-2 weeks of an acute illness, although this time
division is somewhat arbitrary. Common causes of
acute symptomatic seizures are high fever (e.g.
febrile seizures in young children), severe sleep
deprivation, stimulant drugs , withdrawal from
sedative drugs or alcohol, hypoglycemia,
electrolyte disturbances, hypoxia, eclampsia, and
acute neurological illnesses such as stroke, head
trauma, and CNS infection .

7.  Epilepsy is characterized by (1) at least one
epileptic seizure; (2) an enduring predisposition
to epileptic seizures; and (3) associated with
neurobiologic ,cognitive, psychological, and
social consequences.
 Convulsion: intense paroxysm of involuntary
repetitive muscular contractions.
 FIT:??

8.  epilepsy syndrome is an epileptic disorder
characterized by similar features, including
seizure type(s), precipitating factors, age of
onset, etiology,neurologic and
neuropsychological abnormalities,interictal and
ictal EEG findings, and neuroimaging findings .
 An epileptic disease is a specific pathologic
entity with a single, well described etiology. An
example of an epileptic disease would be
Unverricht-Lundberg disease, while progressive
myoclonic epilepsy, with many different
etiologies, would be an epilepsy syndrome.

9.  Simple Focal seizure : with no change in
consciousness.
 Complex Focal seizure :with altered
consciousness.
 Aura :Subjective symptoms attributable to a
seizure (patient experiences but not seen by an
observer), e.g., sensory symptoms, psychic
symptoms such as déjà vu, abdominal
sensations; essentially a simple partial seizure.
 Prodrome :Vague sense, agitation preceding
seizure.
 Reflex epilepsy :Precipitated by stimulus (visual,
eating, contemplating music, reading, startle).
 Postictal :Following a seizure.

10.  Automatism :Coordinated, involuntary
movement during altered consciousness or
postictal.
 Semiology :Clinical seizure manifestations.
 Idiopathic: Unknown cause, often used to
describe genetic-related epilepsies, e.g., benign
rolandic epilepsy.
 Symptomatic Seizures with an identifiable cause
(e.g., brain lesion, metabolic).
 Cryptogenic :Suspected to be symptomatic, but
no symptomatic cause identified on imaging
(e.g., infantile spasms with normal MRI).

11. History of epilepsy
1) Antiquity to medieval period ;were widly
regarded as an attack,possession or seizure of
human victim by supranatural being.
2) Reniassance until the mid of 19th century,were
the development of anatomy, physiolog and
medicine.
3) Modern era:can be traced the 1860s when the
continouse studies of Jhon Hughling Jackson
intiated a remarkable transformation in the
medical and physiological understanding of
seizure.

12. Sakkiku
 The oldest medical reference to epilepsy
consists of two clay tablets written in Assyrian-
Babylonian, which are copies of portions of a
comprehensive medical textbook known as
Sakkiku that dates to (1067 -1046 BCE).
 Although written over 3,000 years ago, they
provide remarkably accurate accounts of some
characteristic clinical manifestations of the
disease.

13. Gelastic epilepsy was
reported for the first time.

14. China 770-220 BCE
 Epilepsy was apparently known in ancient
China, but no chapter devoted to epilepsy is
known to exist in the ancient Chinese medical
literature.
 Epilepsy was generally considered congenital,
but other causes including phlegm and
insufficiency of blood or kidney were
mentioned.

15. India
 The most elaborate descriptions are found in
the Ayurveda (science of life), the oldest known
medical system that evolved continuously from
4500 to 1500 BCE. The views on epilepsy are
attributed to the physician Atreya (about 900
BCE).
 The compendium of Ayurvedic medicine known
as Charaka Samhita (6th century BCE) used the
term apasmara (apa, loss of; smara,
consciousness or memory) for epilepsy.

16. Hippocrates 400 BCE
 The Hippocratic treatise On the Sacred Disease ; It
begins with an attack against common popular
superstitions.
 Contrary to the Babylonian text, the Hippocratic writings
challenged the widespread beliefs of the time that
epileptic seizures were caused by actions of demons or
gods.
 The fundamental difference, however, between
Hippocrates' and other contemporary or older medical
explanations (Assyrian, Indian, and Chinese) lies in the
unequivocal statement about the origin of the
disease(the fact)¦that the cause of this affection
(epilepsy)¦ is in the brain.
 Hippocrates further recognized that all cognitive
functions or emotional manifestations are related to the
brain.

17. Thus, Hippocrates
importantly
dissociated epilepsy
from religion and
magic, arguing
forcibly and
eloquently that
epilepsy was
properly a subject
not for incantation
but for medical
investigation and
study.

18. Post-Hippocratic Hellenistic
and Roman Medicine
 An interesting observation of that time was that
sensory stimuli such as bad smell or the sight of
whirling wheels were potentially epileptogenic.
 Greeks and Romans used this knowledge to
evaluate the fitness of slaves being sold by
having them face the sun while looking through
a turning potter's wheel.
 Intermittent photic stimuli produced by his
marching soldiers were reported to have
triggered some of Julius Caesar's attacks.

19.  In the 2nd century CE, the two main contributors
to epileptology were Galen of Pergamon and
Aretaeus of Cappadocia.
 Galen (129 c 200AD):
- the 1st system of classification based on the
behavioral manifestations (semiology )of seizure.
- 1st who describe aura:recognizes the
importance of stereotyped warning of
impending seizure and used the term aura.

20. Contributions from Islamic
Medicine Islamic medicine, was strongly influenced by
Galenic beliefs.
 The two main Islamic physicians who mostly
influenced the West were Rhazes (865 -925 CE) and
Avicenna (980 -1037 CE).
 Their opinions were based on personal observations
of epileptic phenomena.
 Avicenna considered two possible mechanisms, one
originating in the brain and the other in the nerves,
proposing that a putrid vapor from the distal part
rose to affect the brain.
 Rhazes used bleeding, emetics, and purgatives,
while Avicenna used several traditional herbal and
other pharmacologic agents.

21. Reniassance to the 19th
century
 Remakable advances in neuroanatomy took place
in 16th and 17th ceturies by well known drawings of
Vesalius,Lenardo Da Vinci and Thomas Willis.
 1597 :benign Rolandic epilepsy by Martinus
Rolandus.
 1676: focal motor (jacksonian) seizures by the
philosopher John Locke .
 1667: juvenile myoclonic epilepsy by Thomas Willis .
 1684: the 1st detailed discription of complex partial
seizure by Thomas Willis (pathology of brain and
nervous stock on convulsive diseases).

22.  1772 :1st detailed description of absence seizure
by Swiss neurologist Sameul August Tissot.
 1789 :epilepsy no longer strictly associated with
convulsion, fall and loss of body function(William
Collens).
 1850 :1st effective pharmacotherapy for epilepsy
(Charles Locock) bromide of potassium when
treated young womens with seizure associated
with menstraul cycle(catamenial) 13 of 14
cured.

23.  2nd half of 19th century: anumber of dedicated
colonies and hospitals were established to
house and care for patients with epilepsy :
- Bethel (Beilefeld)
- Chalfont(St.Peter , UK)
- Blackwell Island (New York)
- Ohio state hospital for epilepsy(Gallopitus)
- National hosp. for paralised and epilepsy
(Queen Square, London)

24.  1880 :the birth of modern neurosurgry with
pioneers such as Rickman Godlee and Victor
Horsley working closlely with neurlogists Ferrier
and Jackson who become increaseingly
confedent of the ability to localizing tumors and
other epileptogenic lesions after careful study of
seizure semiology and associted neurological
defects.

25. modren period from jackson
s discharching lesion to the
EEG and beyond
 1870 :the english neurologist Jhon Hughling Jackson
believing that careful examination of focal seizures
would provides clues about the functional
organization of the brain and the cause of seizure.
 (loss of function result from tumour ,stroke
,convulsion result from discharching lesion).
 1879:William McEwen(glasgow surgeon) had
localized and removed a tumor of motor cortex in a
teenage patient based solely on the presence of
focal motor seizure invloving the arm and face.

26. The technological era
 Late 1920s EEG was developed by a German
neuropsychiatrist Hans Berger .
 1935 (spike and dome)EEG of petit mal seizure
after hyperventilation(Davis – Lennox –Gibbs).
 1937 Boston group (paroxysmal cerebral
dysrhythmia).
 1938 :EEG use the precise loclization of the
discharging lesion for surgical therapy of
intractable epilepsy by Herbert Jasper published
1st criteria for localizing an epileptogenic lesion
based on EEG.

27.  The treatment not only for those with evidence
of focal trauma ,focal neurological deficit or
abnormal x ray.
 Penefield operate on two Jasper patients whose
EEG recordings alone suggested a focal
abnormality .
 1941 :1st atlas of EEG by Gibbs.
 EEG become a fundamental axis in the 1st
classification systems adopted by the ILEA in
1969.

28. Late 50s using EEG the surgical
resection had become a safe
and effective treatment for
mesial temporal lobe epilepsy
with high rates of surgical cure
(70%-80%) seizure free with low
rate of morbidity and mortality

29. Recent development
1) Numerous effective antiepileptic drugs.
2) The pursuit of cellular,molecular and genetic
mechanism in the production of seizure.
3) The rise or neuroimaging has profoundly
impacted the diagnosis,classification and
treatment of epilepsy.

30. NEUROSCIENCES HOSPITAL