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Editor convidado:
Journal of LUCIANO DE PAOLA
Epilepsy and
Clinical
Neurophysiology
J Epilepsy Clin Neurophysiol 2004; 10(4):229-232

Epilepsy Across Space and Time: From Ancient History


to Current Beliefs – A Brief Review
Francisco M. B. Germiniani*, Ana C. Crippa**, Eduardo R. Pereira***, Carlos Silvado****,
Luciano De Paola*****
Hospital de Clinicas Epilepsy Program – Federal University of Paraná, Brazil

ABSTRACT
From time to time History and Medicine intersect, as anthropological discoveries try to understand past
medical practices. Epilepsy, as well, as other diseases is often referenced in ancient texts and rituals, and
later in books from the Middle Ages onwards. Contrary to other diseases, epilepsy has attracted more attention
throughout the ages, in part due to its overt clinical manifestations, namely convulsive seizures. The history
of epilepsy literally spans millennia, and accounts of epilepsy can be found as far as Babylonian times. More
specifically, the Sakkiku cuneiform appears to be the earliest written record, dated some 700 years BC. If
that holds true, men have been writing about epilepsy for close to 3000 years. The following (brief) review
acknowledges some of these efforts, merging from curious, haunting or astonishingly accurate, considering
the resources at each given time.
Key words: epilepsy, epilepsy history, cultural aspects in epilepsy.

RESUMO
Epilepsia através do tempo e espaço: da história antiga até conceitos atuais – uma breve revisão
Periodicamente fica evidente a intersecção da História e da Medicina, na medida em que novas descobertas
antropológicas desvendam antigas práticas médicas. Epilepsia, como outras doenças, sofre freqüente alusão
em textos antigos, rituais e livros a partir da Idade Média. O interesse deve-se, possivelmente as suas mani-
festações mais exuberantes, especificamente, as crises convulsivas. A história da epilepsia atravessa milênios
e pode ser traçada desde tempos babilônicos. De fato, a escrita Sakkiku, cuneiforme parece ser a mais antiga
forma de documentação escrita, datando de 700 anos antes da Era Cristã. Se verdadeira esta premissa, a
humanidade vem escrevendo sobre epilepsia ao longo dos últimos 3000 anos ou perto disto. Esta (breve)
revisão reconhece parte desta contribuição, que se mostra por vezes curiosa, outras assustadora e
freqüentemente impressionantemente precisa, considerando os recursos de conhecimento e técnicos dispo-
níveis em cada época descrita.
Unitermos: epilepsia, história da epilepsia, aspectos culturais em epilepsia.

* Neurologist.
** Clinical Neurophysiologist. Neuropediatrician. Assistent Professor of Neurology, Clinical Neurophysiologist.
*** Neurology Resident.
**** Neurologist. Clinical Neurophysiologist. Assistent Professor of Neurology.
***** Neurologist. Clinical Neurophysiologist.
Received Oct 18, 2004; accepted Nov 12, 2004.

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Germiniani F, Crippa A, Pereira E, et al.

EPILEPSY ACROSS TIME: INTERESTING and fasting”. This was later interpreted by some authors
CONCEPTS SURROUNDING THE as a possible mention that fasting – and in modern times
“SACRED DISEASE” it’s equivalent, the ketogenic diet – was considered a
treatment option for epilepsy at the time. Other authors
Epilepsy, and convulsive seizures in particular, has
rebuke this assumption, citing divergent translations of the
often been misinterpreted as a supernatural manifestation
Bible and also that Jesus was supposedly recommending
in both old and current, Western and Eastern cultures.
that the apostles themselves should pray and fast if they
Records of epilepsy trace back to Babylon(1,4), where a
wished to perform the same cure.
person suffering from epilepsy was considered to be
Through the Middle Ages, the treatment of most
possessed by a demon, which supposedly left the person’s
diseases was mired in supernatural concepts. Once again
body at the end of a seizure. There were specific demons
many diseases resulted from divine punishment or inter-
for different types of seizures (gelastic, nocturnal, auto-
vention and/or possession by supernatural forces (evil
matisms, convulsive, and so on), reflecting the knowledge
spirits or the Devil). Thus, penance, praying and suppli-
of doctors from that time of varying semiology and seizure cation to saints, as well as exorcisms, became part of the
types. There was even a verb, “Sibtu”, that meant either therapeutic methods of that time. Saints had the power to
“to be obsessed” or “to seize”. cure the faithful from different illnesses, epileptic attacks
In Asia, China has its first records of epilepsy in the included. To that effect, Saint Valentine, whose patron
8th century, with medical manuscripts referring to epilepsy day is February the 14th, became the Patron Saint
as “Dian” (or “Xian” in other texts), a word that meant of epilepsy(5). There’s some controversy as to Saint
“falling sickness”, or more properly, “convulsion”(1). Valentine’s identity, as there were two martyrs who share
Ancient India(2) had one of the oldest medical systems the title, one a Roman presbyter, the other a bishop of
ever recorded and Indian doctors could distinguish up to Terni, Italy. Nevertheless, it seems that they could be the
four different types of epilepsy, according to changes in same person and there’s reference to Saint Valentine,
the humors, or “Doshas”, that controlled body function. regardless of which, curing an epileptic. Amidst his
The word used to describe epilepsy was “Apasmara”, patronage were both animal and human diseases, including
that can be broken down in two different components: fainting, madness and epilepsy. A votive painting of Saint
“Apa”, a negation term, and “Smara”, which meant Valentine can be found in the church of the Annunciation
“consciousness”. Texts from that period recommended that of the Virgin Mary, in Croatia. In that portrait, Saint
the affected individual should pursue a dietary regimen Valentine is depicted with his eyes gazing upwards, as if
and avoid going to areas considered dangerous for risk of calling for divine assistance. At his feet are two people:
injuries. one an unconscious man foaming at the mouth, the other
In what would later be known as the Western world, a woman in what appears to be an ongoing seizure, with
the Roman games provided a possible cure for epilepsy(3). eyes rolled up and tongue sticking out.
The blood or liver of gladiators killed in the Roman games Across the Ocean, in pre-Columbian America, the
should be consumed as a remedy for epilepsy. This practice Incan Empire flourished and thrived, becoming the largest
possibly had its roots in Etruscan funeral rites, where the civilization South of the Equator. Although Medicine was
blood of a fallen warrior could transmit his strength to highly developed, little documentation on their knowledge
others. The Greeks, prior to the Roman ascension, referred of neurological diseases survived(6). The Incan term for
to epilepsy in Hippocrate’s “The Sacred Disease”, a text “Sonko-Nanay” could be split in its components. “Sanko”
in which Hippocrates postulates that epilepsy was a meaning both the center of the human body and the mind,
disorder of the brain(4). This idea was later discarded, located in the precordial region and upper abdomen; and
resurfacing only in the 18th and 19th centuries. “Nanay”, which meant disease: thus the whole word meant
As the Roman Empire fell and the Medieval System a lesion of the mind or paralysis. Variations of the word
emerged, leading to the period known as the Middle Ages, were used for describing different symptoms, such as
Christendom spread across Europe, epilepsy was once again absence and tonic-clonic seizures and even sudden death.
attributed to demonic possession. Even the Bible, in the The later could possibly represent the first account of a
New Testament, made reference to this belief(5). In the particular condition, known by the acronym SUDEP
Gospel of Mark, in the “lunatic’s” passage, Jesus casts out (sudden unexplained death in epilepsy). Incan royalty was
a “spirit” ordering it to leave the body of a young boy not spared, as the wife of the last Incan ruler, Chimbo
suffering from seizures. Later, in the same passage, when Mama Cava, suffered from epilepsy. One of her seizures
Jesus is inquired by His followers why they could not have was depicted in a conqueror’s drawing, showcasing her in
performed the same task when attending the boy, Jesus a resting position, with flexed arms, pursed lips and rolling
replied that “This kind came out by nothing but prayer eyes. Once again myth played a role in explaining the

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Epilepsy across space and time: from ancient history ...

cause of epilepsy as some seizures could be the result of Another Hungarian study recently published(11)
avenging ancestors. employed a questionnaire to survey in two different times
(1994 and 2000) public perceptions regarding epilepsy.
EPILEPSY ACROSS CULTURES: Epileptic patients or their relatives were excluded; in both
COMMONALITIES AND DISTINGUISHED surveys 1,000 people were addressed. Even though the
PERSPECTIVES percentage of people who could identify correct causes of
epilepsy (e.g.: birth trauma, brain injury, disease of the
Even though civilization as a whole progressed over
nerves, heredity) remained stable (from 45,7% to 48,7%),
time, still nowadays some countries and cultures believe
a large proportion of respondents (45,4%) did not know
that epilepsy is caused by outside sources. In Haiti, where
any cause of epilepsy and it was considered a form of
Voodoo priests still conduct ritual healings, epilepsy is
insanity by 17,2% of the interviewed people. Conversely,
considered to be the result of possession by “loas”,
attitudes towards people with epilepsy had a positive
specifically “Marinnette”(7). In one report, a patient
presumably possessed by this entity suffered burns during change, as there was a significant reduction from 1994 to
a seizure and was later proved to be suffering from tempo- 2000 of the proportion of people who objected to their
ral lobe epilepsy with bilateral foci. In Africa, some people children being in contact with epileptic patients or who
in certain areas believe that epilepsy is contagious and perceived negatively marrying someone with epilepsy. Also,
sometimes avoid contact with people while they are having more people favored equal employment.
a seizure. In Brazil a recent study by Arida et al.(12) evaluated
Recently, an American journalist, Anne Fadiman, exercise habits in epileptic patients. Among the barriers
published both a book and an article, aptly named “The to engaging in physical activities, the most common
spirit catches you and you fall down”(8), focusing in the epilepsy-specific cause was fear of being embarrassed by
beliefs of Laos immigrants living in the United States. In having a seizure while exercising. Surprisingly, a great
the article she reports the case of a Hmong (ethnic group number of patients (15%) were advised by a physician to
from Laos) girl who suffered from Lennox-Gastaut avoid most types of exercise, a figure similar to the
Syndrome. Her family believed, as part of their culture proportion of patients who were discouraged from
system and society, that people with epilepsy, because of exercising by a family member or friend (14%). In addition,
their seizures, had an innate power to become healers. The other non-specific related causes for not exercising
Hmong shamans were chosen by healing spirits that would included excuses commonly used by healthy subjects, such
induce the seizures, a pre-requisite for entering in a tran- as not having time to exercise (25%), getting tired after
ce and being able to heal other people by acting in a sort exercise (38%) and those who did not like to exercise
of spiritual plane. This particular girl was administered (18%).
different medications in varying combinations over several Psychiatric co-morbidities, however, apparently do
months, until going into status and ending up in a not vary that much in different populations, with similar
vegetative state. Cultural barriers played a large role in severe social issues in both developed and developing
the outcome, as several times no translator was available countries(13). To that effect, a joint review study by
to help either the physicians or the family to interact and Matsuura and Trimble(14), of Japanese epileptic patients
also because the family regarded the physicians with showed that the clinical presentations of psychoses were the
distrust. same as those reported in European observational studies.
Even in some parts of Europe religion is still inter- Finally, non-epileptic seizures, a rather frequent cau-
mingled with epilepsy. In 1999 a study of the prevalence se of intractable seizures (20%) in tertiary epilepsy centers,
of epilepsy in rural Hungary(9) showed that of the do not seem to differ in their clinical presentation in
415 interviewed patients, 65% had consulted with reli- different cultures, as reported in a recent Indian study(15).
gious figures at some point during the course of their In brief, in spite of all the cultural and information
disease. advances, some misconceptions about epilepsy still remain
Despite current information resources leading to in modern times, mostly related to a belief that epilepsy
widespread access to knowledge in urban areas, not can be the result of supernatural causes. Other aspects,
previously available for lay people, epilepsy still carries such as prejudice or co-morbidities, do not seem to differ
several social stigmas, even among people who do not greatly between Eastern or Western cultures. There’s still
perceive it as some sort of preternatural phenomenon. a bulk of regional issues, like predominant etiologies, access
Epileptic patients, regardless of the country they live in, to medication, social issues, access to comprehensive
have fewer opportunities for marriage, employment and centers, to name a few, that are too broad to evaluate in
education(10). conjunction and are beyond the scope of this review.

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9. Karaagac N, Yeni SN, Senocak M, Bozluolcay M, Savrun FK,


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