If you began having your first seizures today, you would likely visit your local doctor for help. They might refer you to an epilepsy treatment center where you would have tests and be assessed with an EEG. You would then be put on a course of anti-epilepsy drugs and could track your progress with an app like Epsy.
But this approach to seizures is very new in the history of epilepsy treatment – until about 200 years ago the condition was believed to be caused by magic or supernatural forces. Today we know this view is untrue and outdated, and instead apply treatments based on modern medicine. These scientific and modern approaches help millions of people live seizure free.
This is the second blog in our series of three articles on the history of epilepsy – read the first article on epilepsy in the ancient world here.
From superstition to science
During the Renaissance (1300-1600 AD), a period when Europeans rediscovered ancient Greek approaches to science, people began researching causes of epilepsy. Scientists like Frenchman Jean Fernel (1497 – 1558 AD) speculated that seizures were caused by poisonous vapors affecting the brain. While the science was wrong, people like Fernel introduced the possibility that seizures were caused by biology, rather than supernatural causes.
During the 19th and 20th centuries (1800 – 2000 AD) major advances were made in understanding epilepsy. French researchers in the 1800s made many important discoveries and identified different kinds of seizures. For example, Etienne Dominique Esquirol (1772 – 1840) described the difference between ‘petit’ and ‘grand mal’ seizures (often referred to as absence and tonic-clonic seizures).
Another important figure from this period was English neurologist John Hughlings Jackson (1835 – 1911 AD) who is seen as the ‘father of modern epilepsy’. Jackson was the first to describe epilepsy on an anatomical basis, and he showed that many seizures were caused by damage to specific parts of the brain. He was also the first to describe how seizures can start in one part of the brain, then spread to other locations (a process called ‘generalization’).
While Jackson’s work was important, he believed seizures were caused by chemical discharge. The first people to prove that epilepsy was related to electrical activity were German scientists Gustav Fritsch and Eduard Hitzig. In 1870, they showed it was possible to cause seizures in dogs by applying electric current to the animals’ brains (this experimental technique is called ‘kindling’).
During the 20th Century research into epilepsy accelerated. A major figure in the history of epilepsy was French scientist Henri Jean Pascal Gastaut (1915–1995) who made a big contribution to our understanding of epilepsy with his work using electroencephalogram (EEG). For this technique numerous electrodes are placed on the scalp allowing the physician to monitor brain activity through neuron activation. Gastaut described the different kinds of brain wave patterns and identified a number of specific kinds of epilepsy which now bear his name (such as Lennox-Gastaut syndrome).
History of epilepsy treatment in the scientific era
Over the last 200 years humanity has made great advances in the treatment of epilepsy. Today around two-thirds of people with epilepsy control their seizures using medication. Other treatment options include medical procedures like special diets, vagus nerve stimulation, stimulation deep inside the brain, or surgery to remove parts of the brain responsible for the seizures.
The first ‘medicine’ to treat epilepsy was potassium bromide which was introduced by English doctor Sir Charles Locock in 1857. This became the main treatment for epilepsy until 1912 when German physician Hauptmann discovered phenobarbital. Until the 1970s there were only a handful of drugs available to treat epilepsy. But then in 1975 the US National Institute of Neurological Disorders and Stroke created an anti-seizure research program which led to the creation of many new drugs. There are currently more than 25 drugs available, which can be used in different combinations and doses based on your diagnosis.
Other treatments have also developed alongside drugs. For instance, physicians in England conducted some early brain surgery as early as 1831, the ketogenic diet (strictly reduces carbohydrates) was introduced in 1911, and vagus nerve stimulators came in 1997.
Major advances in epilepsy treatment
The last two centuries have seen major advances in our understanding and treatment of epilepsy – and that research has allowed millions more people to live seizure free or manage their epilepsy so they can live healthy and fulfilling lives.
While our scientific understanding of epilepsy has improved dramatically, changing people’s perceptions of the diseases takes longer. But as we will see in the next article on the history of epilepsy, there have been major improvements in people’s attitudes too.