1. Introduction

Epilepsy is the most common neurological disorder globally, affecting approximately 50 million people of all ages [1]. It is one of oldest diseases described in literature from remote ancient civilizations 2000–3000 years ago. Despite its old description and its wider spread, epilepsy is still surrounded by myth and prejudice which can be overcome only with great difficulties. These myths and prejudice might have its historical origin. The aim of this introductory chapter is to follow the origin of epilepsy in ancient cultures, highlight the myth and stigmatism associated with epilepsy, and follow the major milestone in its development as a disease entity. The term epilepsy is derived from the Greek verb epilambanein, which by itself means to be seized and to be overwhelmed by surprise or attack. Therefore, epilepsy means a condition of getting over, seized, or attacked [2].

## 2. The major milestones in the history of epilepsy

The history of epilepsy goes together with the history of humankind in the globe. The earliest recorded account of epilepsy can be traced to the earliest civilization developing in Mesopotamia (the old name of the country IRAQ) almost 2000–3000 BC. These earliest establishments include the Sumerian, Babylonian, Assyrian, and Akkadian civilizations. The first description of epilepsy was written in the Akkadian language about 2000 BC in which the author described a condition similar to epileptic seizures in a patient. He described a patient whose neck turns to the left side, with his hands and feet being tense, with his eyes widely opened, and with his mouth drooling froth without him knowing. The condition diagnosed as antasubbû translated as the hand of sin brought about by the god of the Moon [5].

In a tablet from the Babylonian series (1067–1046 BC) present in the Babylonian collection of the British Museum(47,753), we find a report containing a detailed description of the symptoms of the condition known today as epilepsy with the supernatural forces suggested as an etiology (Figure 1). This table is written in Neo-Babylonian script dated approximately at the middle of the first millennium BC [4]. In this tablet, epilepsy was called Sakikku miqtu ("falling disease"), and the author describes various signs for the diagnosis, treatment, and prognosis of epilepsy. The etiology of epilepsy was presumed to be the effect of demons, evil spirits, and ghosts, and features of generalized seizures, simple and complex partial seizures, gelastic seizures, nocturnal epilepsy, febrile seizures, status epilepticus,

### Figure 1.

British Museum Babylonian collection; Epilepsy tablet (47753) is an important Neo-Babylonian manuscript of Tablet 26 of the Diagnostic Handbook, the canonical Akkadian medical diagnostic series, composed of 40 tablets arranged into six chapters. This tablet gives symptoms of epilepsy and assigns disease names and etiologies to the various ways that the symptoms present themselves. Adopted by public domain at http://cdli.ox.ac.uk/ wiki/doku.php?id=tablet\_on\_epilepsy.

Goddess of the Moon, on those with epilepsy and its cure could be of divine origin [3]. On the other hand, it might reflect the ambiguity of the disease, affecting body and mind, inspires, and has an Apollonian aspect. It is also considered as a disease of the genius since men like Persian King Cambyses II (522 BC), the Roman

The Hammurabi Obelisk containing his legislation (1790 B.C.). From the Louvre collection. Adopted by public

The father of the medicine, Hippocrates (Figure 3), in his book On the Sacred Disease (400 BC) (although still a controversy exists about the book authorship), who raised the first dispute about the divine origin of the epilepsy, had said "This disease is in my opinion no more divine than any other; it has the same nature as other diseases and the cause that gives rise to individual diseases." Hippocrates argued that epilepsy originates in the brain when an excess of phlegm enters the blood and is not of divine nature. He criticizes previous doctors who attribute epilepsy to divine intervention by stigmatizing them as magicians and charlatans [9]. Hippocrates was also the first to attempt a scientific approach toward the study of epilepsy by suggesting a possible etiology and therapy for the disease. He suggests brain dysfunction and heredity factors play a role in the etiology of epilepsy [10, 11].

By calling epilepsy as the great disease, he originates the term grand mal, and by linking convulsion to head injuries, he gives the base for the term posttraumatic epilepsy. He noticed that injury affecting the left side of the head could produce a right-sided convulsion. He describes the symptoms of focal seizures and suggests

emperor Caesar, and the hero Hercules are said to have had epilepsy [3].

domain at https://www.pinterest.com/pin/178173728990949335/.

Introductory Chapter: Epilepsy—The Long Journey of the Sacred Disease

DOI: http://dx.doi.org/10.5772/intechopen.85377

Figure 2.

5

chronic epilepsy, narcolepsy, and postictal states were described. This is by far the first written account of epilepsy [6, 7]. The king Hammurabi in his legislation (1790 BC) also refers to epilepsy (Figure 2). The legislation stated that a person with epilepsy could not marry, or testify in court, and a slave could be returned and the money refunded if bennu appeared within the month after the purchase. According to the researcher Marten Stol, bennu is another term for epilepsy [8].

The ancient Egyptian civilization medical reports (1700 BC) also contribute to the history of epilepsy by reporting five separate patients who shudder exceedingly. Probably these were the first reports of focal epilepsy following cortical irritation caused by examination or probing of wound or from an injury, e.g., gaping wound of the head. The last represents the earliest description of posttraumatic epilepsy [3].

In Greek civilization, epilepsy was referred to by many names including seliniasmos, sacred disease, Herculean disease, and demonism. These names related either to the etiology of the condition or to a figure. The scariness of the disease in Greek civilization may be related to the belief that epilepsy is vengeance of Mene,

Introductory Chapter: Epilepsy—The Long Journey of the Sacred Disease DOI: http://dx.doi.org/10.5772/intechopen.85377

### Figure 2.

chronic epilepsy, narcolepsy, and postictal states were described. This is by far the first written account of epilepsy [6, 7]. The king Hammurabi in his legislation (1790 BC) also refers to epilepsy (Figure 2). The legislation stated that a person with epilepsy could not marry, or testify in court, and a slave could be returned and the money refunded if bennu appeared within the month after the purchase. According

British Museum Babylonian collection; Epilepsy tablet (47753) is an important Neo-Babylonian manuscript of Tablet 26 of the Diagnostic Handbook, the canonical Akkadian medical diagnostic series, composed of 40 tablets arranged into six chapters. This tablet gives symptoms of epilepsy and assigns disease names and etiologies to the various ways that the symptoms present themselves. Adopted by public domain at http://cdli.ox.ac.uk/

The ancient Egyptian civilization medical reports (1700 BC) also contribute to the

history of epilepsy by reporting five separate patients who shudder exceedingly. Probably these were the first reports of focal epilepsy following cortical irritation caused by examination or probing of wound or from an injury, e.g., gaping wound of the head. The last represents the earliest description of posttraumatic epilepsy [3]. In Greek civilization, epilepsy was referred to by many names including seliniasmos, sacred disease, Herculean disease, and demonism. These names related either to the etiology of the condition or to a figure. The scariness of the disease in Greek civilization may be related to the belief that epilepsy is vengeance of Mene,

to the researcher Marten Stol, bennu is another term for epilepsy [8].

Figure 1.

4

wiki/doku.php?id=tablet\_on\_epilepsy.

Epilepsy - Advances in Diagnosis and Therapy

The Hammurabi Obelisk containing his legislation (1790 B.C.). From the Louvre collection. Adopted by public domain at https://www.pinterest.com/pin/178173728990949335/.

Goddess of the Moon, on those with epilepsy and its cure could be of divine origin [3]. On the other hand, it might reflect the ambiguity of the disease, affecting body and mind, inspires, and has an Apollonian aspect. It is also considered as a disease of the genius since men like Persian King Cambyses II (522 BC), the Roman emperor Caesar, and the hero Hercules are said to have had epilepsy [3].

The father of the medicine, Hippocrates (Figure 3), in his book On the Sacred Disease (400 BC) (although still a controversy exists about the book authorship), who raised the first dispute about the divine origin of the epilepsy, had said "This disease is in my opinion no more divine than any other; it has the same nature as other diseases and the cause that gives rise to individual diseases." Hippocrates argued that epilepsy originates in the brain when an excess of phlegm enters the blood and is not of divine nature. He criticizes previous doctors who attribute epilepsy to divine intervention by stigmatizing them as magicians and charlatans [9]. Hippocrates was also the first to attempt a scientific approach toward the study of epilepsy by suggesting a possible etiology and therapy for the disease. He suggests brain dysfunction and heredity factors play a role in the etiology of epilepsy [10, 11].

By calling epilepsy as the great disease, he originates the term grand mal, and by linking convulsion to head injuries, he gives the base for the term posttraumatic epilepsy. He noticed that injury affecting the left side of the head could produce a right-sided convulsion. He describes the symptoms of focal seizures and suggests

3. Epilepsy evolution as a disease entity

DOI: http://dx.doi.org/10.5772/intechopen.85377

Introductory Chapter: Epilepsy—The Long Journey of the Sacred Disease

different types of epilepsies.

studies on convulsions [19].

7

The first liberation of epilepsy from religious theories such as divine punishment or possession was made in the eighteenth and nineteenth centuries [19, 20]. In these centuries, a tremendous advance in the research on epilepsy with great emancipation from religious superstitions was made. At the beginning of the eighteenth century, epilepsy was regarded as idiopathic disease derived from brain and other internal organs. The work of William Culen (1710–1790) and Samuel A. Tissot (1728–1797) builds up the bases of the modern epileptology, and they described

At the beginning of the nineteenth century, French physicians started to publish their research in the field of epileptology. Maisonneuve (1745–1826) [21], Calmeil (1798–1895) [22], and Jean-Etienne Dominique Esquirol (1772–1840) are among the famous physicians who work in this field. Maisonneuve stressed the importance of hospitalization of epileptic patients, categorized epilepsy into idiopathic and sympathetic, and described the so-called sensitive aura of sympathetic epilepsy. Esquirol distinguished between petit and grand mal and along with his pupils Bouchet and Cazauvieilh studied systematically insanity and epilepsy, conducting clinical and postmortem studies [19, 20]. In the second half of the nineteenth century, the etiology and pathophysiology of epilepsy and the topographic localization of epileptic seizures were stressed on. At that time important works were published by prestigious physicians such as Theodore Herpin (1799–1865) in 1852 and 1867, Louis François Delasiauve (1804–1893) in 1854, John Russell Reynolds (1828–1896) in 1861, and Sir William Richard Gowers (1845–1915) in 1881 [19]. The physiologist Fritsch (1838–1927) and the psychiatrist Hitzig (1838–1907) give the first proof that the brain was the origin of epilepsy. They presented experiments in which they provoked seizures by electric stimulation in the brain cortex of dogs [23]. An English neurologist, John Hughling Jackson (1835–1911), studied the pathological and anatomical bases of epilepsy extensively, and he set the scientific bases of epileptology. Jackson in 1873 defined epilepsy as the name given for occasional, sudden, excessive, rapid, and local discharges of gray matter. The presence of localized lesions on the cortex involved by epilepsy was the core of his

A Spanish pathologist, histologist, and neuroscientist, Santiago Ram'ony Cajal (1852–1934) at the beginning of the twentieth century, made an important advance in the field of the microscopic structure of the brain and nervous system. He was awarded with the Nobel Prize in 1906 for his advancement in the description of the structure of the neurons and synapses by employing the Golgi staining in the study of the nervous system. The famous book The Borderlands of Epilepsy, published by Sir William Richard Gowers in 1907, focuses on vagal and vasovagal attacks, faints, vertigo, migraine, and some sleep symptoms, especially narcolepsy. Lennox (1884–1960) and Cobb (1887–1968) during the 1920s studied the effects

of starvation, ketogenic diet, and altered cerebral oxygen in seizures. In their published monographs entitled "Epilepsy from the Standpoint of Physiology and Treatment" and "Epilepsy and Related Disorder" and their important paper summarizing their research entitled "The Relationship of Certain Physiochemical Processes to Epileptiform Seizures), they concentrate on the effects of various stimuli to the generation of epileptic convulsions. Most of these studied stimuli, as starvation, ketogenic diet, and lack of oxygen, give negative results. [24–26]. The relationship of behavioral changes to temporal lobe lesion was discovered during the 1940s by Klüver (1897–1979) and Bucy (1904–1992) who noticed this association on monkeys. Jasper (1906–1999) and Kershmann in 1941 proved that the

temporal lobe is the site of origin of psychomotor seizures [27].

Figure 3.

Hippocrates wrote on the sacred disease 400 B.C. Adopted from the free domain https://en.wikipedia.org/wiki/ Hippocrates.

many precipitating factors, among these are changes in the winds and temperature, exposure of the head to the sun, crying, and fear, and also he gives a prognostic clue by suggesting that disease manifesting at an early age has worse prognosis, and for older peoples, the prognosis is better. He considered epilepsy a curable disease unless if it is of long duration and ingrained as to be more powerful than the remedies that are applied [12]. Furthermore, Hippocrates in his book On the Sacred Disease described the first neurosurgical procedure, a craniotomy. He said craniotomy should be performed at the opposite side of the brain of the seizure in order to spare patients from "phlegmad" that caused the disease [13]. Many other famous Greek philosophers also wrote about epilepsy in their works like Plato (428– 348 BC), who suggested in his laws a specific punishment for people selling slaves with epilepsy. Also Aristotle (384–322 BC), in his works Problems, On Sleep and Waking, and Ethica Nicomachea, presented his theories and views about epilepsy that had impressed many physicians in the post-Hippocratic and even Medieval era which had led the Catholic Church to validate his teaching and work and consider it as indisputable and beyond any criticism [3, 14–16]. The dominance of the Catholic Church during the era of the Middle Ages led to the continued existence of religious and magic beliefs about epilepsy.

In the old Chinese civilizations, also there are some references to the disease. Old Chinese physicians discuss a condition similar to generalized convulsions, T'ien-Hs'ien (770–221 BC). They thought that emotional shock bore by the mother during pregnancy is the cause for epilepsy in a child. Later on, Chinese scientist tries to classify seizures according to the age at onset, clinical symptoms, and the possible etiology. During the Tang dynasty (682 AD), two different classifications were proposed on the basis of the resemblance of noises a patient might utter during seizures to voices of animals and different organs as presumed sites of seizure origin [17, 18].
