The oldest detailed account of epilepsy is on a Babylonian tablet in the British Museum. This is a chapter from a Babylonian textbook of medicine comprising 40 tablets dating as far back as at least 2000 BC. The tablet accurately records many of the different seizure types we recognize today. It emphasizes the supernatural nature of epilepsy, with each seizure type associated with the name of a spirit or god - usually evil. Treatment was, therefore, largely a spiritual matter.
The Babylonian view was the forerunner of the Greek concept (5th century BC) of "The Sacred Disease", as described in the famous treatise of that title by Hippocrates. However, Hippocrates believed that epilepsy was not sacred, but a disorder of the brain-- a revolutionary view. He did not believe "that a human could be invaded by a god, the basest by the most pure." He recommended physical treatments and stated that if the disease became chronic, it was incurable.
The word epilepsy is derived from the Greek "epilepsia" which means "to take hold of" or "to seize."
Hippocrates' view of epilepsy as a brain disorder did not begin to take root until the 18th - 19th centuries. The intervening 2000 years had been dominated by the earlier supernatural views. This was reinforced, for example, in the account of Christ casting out a devil from a young man with epilepsy (Mark, 9:14-29; also in Matthew and Luke).
Throughout this time people with epilepsy were viewed with fear, suspicion and misunderstanding, and were subjected to enormous social stigma. They were treated as outcasts and punished. However, some of them succeeded and, in fact, became famous the world over. Among them were Julius Caesar, Czar Peter the Great of Russia, Pope Pius IX, the writer Fedor Dostoevsky, the poet Lord Byron and others.
Even today, people with epilepsy continue to suffer discrimination in the family, marriage, employment, law, education and society.
In Europe, since medieval times St. Valentine has been the patron saint of people with epilepsy. Sites of pilgrimages included Rome and Terni (where he was Bishop) in Italy, Ruffach in France (where a hospital for epilepsy was built), Poppel in Belgium, and Passau in Germany.
In the 19th century, as neurology emerged as a new discipline, distinct from psychiatry, the concept of epilepsy as a brain disorder became more widely accepted, especially in Europe and North America. This helped to reduce the stigma associated with the disorder. Bromide, introduced in 1857 by Sir Charles Locock, as the world's first effective antiepileptic drug, became widely used in Europe and North America during the second half of the last century.
A hospital for the "paralyzed and epileptic" was established in London in 1857. At the same time a more humanitarian approach to the social problems of epilepsy resulted in the establishment of epilepsy "colonies" for care and employment. Examples include Bielefeld-Bethel in Germany, Heemstede in Holland, Chalfont in England, Zurich in Switzerland, Dianalund in Denmark, and Sandvikain in Norway.
The foundation of our modern understanding of the derangement of function seen in epilepsy (pathophysiology) was also laid in the 19th century with the proposal by Hughlings Jackson (1873), a London neurologist, that seizures were the result of sudden brief electro-chemical discharges of energy in the brain - the character of the seizures depending on the location and function of the seat of the discharges.
Soon afterwards the electrical excitability of the cortex of the brain in animals and man was discovered by David Ferrier in London and Gustav Theodor Fritsch and Eduard Hitzig in Germany.
Working in Germany during the 1920s, Hans Berger, a psychiatrist, developed the human electroencephalograph (EEG "brainwaves"). Its important application from the 1930s onwards was in the field of epilepsy. The EEG revealed the presence of the electrical discharges in the brain. It also showed different patterns of brainwave discharges associated with different seizure types.
The EEG helped to locate the site of seizure discharges and expanded the possibilities of neurosurgical treatments, which became much more widely available from the 1950s onwards in London, Montreal and Paris.
During the first half of this century the main drugs for the treatment of epilepsy were phenobarbitone (1912) and phenytoin (1938). Since the 1960s there has been an accelerating process of drug discovery, based in part on a much greater understanding of the electrochemical activities of the brain, especially the excitatory and inhibitory neurotransmitters.
In developed countries in recent years, several new drugs have come on to the market. Seizures can now be controlled in approximately three-quarters of newly-diagnosed children and adults.
Another recent stimulus towards the understanding and treatment of epilepsy in the last few decades has been the developments in structural and functional neuroimaging, especially computer tomography (CT) scanning, magnetic resonance imaging (MRI) and MRI spectroscopy and positron emission tomography. Such techniques have revealed many of the more subtle brain lesions responsible for epilepsy. Any type of brain lesion (e.g. trauma, congenital, developmental, infection, vascular, tumour, degenerative) can lead to epilepsy in some patients.
During the last few decades greater attention has been paid to the psychological and social needs and quality of life issues of people with epilepsy, although progress is slow and services are still poor.
Most of the advances in developed economies are of little or no relevance to the 80% of people with epilepsy who live in developing countries. For most of these people the older supernatural views, social stigma and discrimination still prevail. Even in the developed world, the disorder is still shrouded in secrecy, and people prefer not to reveal or discuss their illness.
Of the estimated 40 million people in the world with epilepsy, 32 million have no access to treatment at all - either because services are non existent or, just as importantly, because epilepsy is not viewed as a medical problem or a treatable brain disorder.
The International League Against Epilepsy, a world-wide professional organisation, was founded in 1909 and is growing rapidly, with chapters in 60 countries.
The International Bureau for Epilepsy, the equivalent lay organisation, was founded in 1962 and is also rapidly expanding, with 50 national chapters.
In 1997, these two organisations joined forces with the World Health Organisation in the Global Anti-Epilepsy Campaign aimed at improving prevention, treatment, care and services for those with epilepsy and raising public awareness of the disorder and its acceptability.
