5. Misconception about epilepsy

by a German physician, Hauptmann (1881–1948), in 1912. The drug company Bayer, under the brand name Luminal, introduced phenobarbital to the market. Hauptmann used phenobarbital as a sedative for his epileptic patient, and he discovered that their epileptic attacks were susceptible to the drug. The absence of the sedative effect of phenytoin, the next drug used as antiepileptic, leads to the delay of its use as anticonvulsant until 1938 despite its synthesis by Heinrich Biltz (1865– 1943) in 1908. It was introduced as an anticonvulsant by Merritt (1902–1979) and Putnam (1894–1975) in 1938 under the name Dilantin. Phenytoin substitutes potassium bromide and phenobarbital as the first-line drug of choice for the prevention of partial and tonic seizures and for the treatment for acute cases of epilepsies and

A new antiepileptic drug was introduced in 1946 under the name of trimethadione. Richards and Everett report the use of trimethadione to prevent pentylenetetrazol- induced seizures and for the treatment of absence seizures. In the 1950s, a set of new antiepileptic drugs were introduced: carbamazepine in 1953, primidone in 1954, ethosuximide in 1958, and sodium valproate in 1963 [43]. Serum level of antiepileptic drugs was first introduced in 1960 by Buchtal and Svenmark [44]. Other antiepileptic drugs were introduced in the 1970s, including clobazam, clonazepam, and piracetam. The last decade of the twentieth century and the early years of the twenty-first century mark the beginning of the use of new antiepileptic drugs. Among these drugs are vigabatrin (1989), lamotrigine (1990), gabapentin (1993), felbamate (1993), topiramate (1995), tiagabine (1998), zonisamide (1989 in Japan and 2000 in the USA), levetiracetam( 2000), pregabalin (2004), rufinamide (2004), lacosamide (2008), eslicarbazepine (2009), and perampanel (2012). The field of anticonvulsant drugs is dynamic and in the last two decades a new generation of antiepileptic drugs introduced to the market, and there are a number of very new antiepileptic drugs which are under various stages of drug development such as brivaracetam and retigabine. The aim of the researches in this field is to improve tolerance and effectiveness of the drugs and to improve the quality of the life of the patient through improvement in the pharmacokinetics, safety, and efficacy of

The role of diet in the management of epilepsy dated back to the era of Hippocratic were fasting and other types of diet used for the treatment of epilepsy [13]. The use of ketogenic diet (diet full with fat and low in protein and carbohydrates) for the treatment of epilepsy started in 1911 by two French physicians, Guelpa and Marie, who reported a decrease in the number of seizures in 20 children and adults with epilepsy when treated with ketogenic diet [45]. In 1922, an American physician, Hugh Conklin, stresses the importance of the ketogenic diet in the management of epilepsy since he believed that epilepsy caused by toxins damages the brain cell. He had a personal interest in ketogenic diet and tried to treat his nephew, who suffered from drug-resistant epilepsy, by this method. By using ketogenic diet, he had encouraging results. Since that time, many authors published many papers, but

none explained the anticonvulsive mechanisms of ketogenic diets [46, 47]. In 1831, the first neurosurgical operation for an epileptic patient with brain abscess was done by Heyman [30]. Posttraumatic epilepsy was the most common indication for the operations done at that time. At the beginning of the twentieth century, a great advance in neurosurgical operations for epileptic patients is done, started by Dandy (1886–1946) who introduced hemispherectomy in 1923 and continued by Gibbs and Lennox in 1938 who introduced the notion of operating the epileptogenic focus [31, 48]. A further advance in the surgical procedure for epileptic patients was done by Penfield, Jasper, and Theodor Brown Rasmussen (1910–2002). They introduce the Foerster method for removing epileptogenic lesions in epileptic patients, invented Montreal procedure (using local anesthesia to

status epilepticus [38–42].

Epilepsy - Advances in Diagnosis and Therapy

these drugs.

10

Throughout the history of epilepsy, many misconceptions and wrong beliefs about the disease are conveyed. Some of these are referred to earlier in this chapter. These misconceptions and beliefs are variable in different parts of the world, from society to society and era to era, and it may lead to rejection, denial of education, and isolation in both developed and developing countries.

In the antiquity, one of the popular beliefs was that epilepsy is a contagious disease. People used to spit at a person with seizure and refuse to use the same dish. These beliefs continued in the Middle Ages where the clergy and synods of the early Christian church separated the possessed from the faithful because they thought that the possessed would desecrate the holy objects and would infect the sharing dishes and cups [53]. Berthold of Regensburg (1220–1272), a thirteenth-centurypreacher, added breath as a rout of infection, and he warns people not to talk or bath with patients with seizures since the contagious nature of the infection is transmitted through the evil breath [4]. The beliefs that epilepsy is an infectious process continued until the eighteenth century [54].

### Figure 6.

Avicenna (Ibn Sina) (A) and Abubakr Muhammad ibn Zakariyya al-Razi (B) written manuscripts about epilepsy, which had great influences on the students and universities in Eastern and Western world till the 18 century. Adopted from the free Domain http://www.muslimphilosophy.com/sina/gal/IS-gal-16.htm and https://www.researchgate.net/figure/Portrait-of-Abubakr-Muhammad-ibn-Zakariyya-al-Razi-or-Rhazes-865-925-CE\_fig1\_236331515.

## Epilepsy - Advances in Diagnosis and Therapy

Other wrong beliefs were that people with epilepsy were demoniacs and that seizures caused by an unclean dumb and deaf spirit were common among priests in the old Christian world. These beliefs can be attributed to the biblical story of Jesus healing a boy with symptoms of an epileptic seizure. In the medieval Islamic era, we cannot find referring to epilepsy as caused by demons in any of the scientific texts of epilepsy written in that era. The two famous Islamic physicians, Avicenna and Mohammed Ibn Zakariya AL-Razi (Figure 6), had written manuscripts about epilepsy, which had great influences on the students and universities in Eastern and Western world till the eighteenth century [55]. Nowadays, still, misconceptions and wrong beliefs are prevalent and widely spread among societies from developing and developed countries throughout the world.

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