Historical Overview of the "Firing" Liaison between Brain Tumors and Epilepsy.

This review addresses, in a critical historical perspective, the link between seizures and endocranic neoplasms. Folkloric descriptions of epilepsy can be found in writings from ancient cultures. Hippocrates first provided a medical interpretation. In 1770, Tissot published Traité de l'épilepsie, a milestone in epileptology, whereas the 19th century is considered the golden era of epileptic studies. In 1882, the father of modern epileptology, Jackson, in his article Localized Convulsions from Tumour of the Brain, reported a case of a patient affected by typical Jacksonian seizures in the presence of a brain tumor. However, he did not establish a direct correlation between brain tumors and epilepsy, and an explanation for his clinical case was lacking. Before Jackson's article, other authors reported similar cases, but only Gairdner in 1834 published a report suggesting the concept of a direct relationship between epilepsy and a brain tumor. From the beginning until the mid of the 20th century several authors reported seizures attributed to intracranial tumors, and in recent years studies have focused on the pathogenesis of tumor-related seizures. Biochemical and molecular changes in brain tumors and their environment opened unprecedented working hypotheses on epileptogenesis and on treatment of epilepsy associated with brain tumors.

Psychosurgery in the History of Stereotactic Functional Neurosurgery.

The paper invites to reappraise the role of psychosurgery for and within the development of functional stereotactic neurosurgery. It highlights the significant and long-lived role of stereotactic neurosurgery in the treatment of severe and chronic mental disorders. Stereotactic neurosurgery developed out of psychosurgery. It was leucotomy for psychiatric disorders and chronic pain that paved the way for stereotactic dorsomedial thalamotomy in these indications and subsequently for stereotactic surgery in epilepsy and movement disorders. Through the 1960s stereotactic psychosurgery continued to progress in silence. Due to the increased applications of stereotactic surgery in psychiatric indications, psychosurgery's renaissance was proclaimed in the early 1970s. At the same time, however, a public fearing mind control started to discredit all functional neurosurgery for mental disorders, including stereotactic procedures. In writing its own history, stereotactic neurosurgery's identity as a neuropsychiatric discipline became subsequently increasingly redefined as principally a sort of "surgical neurology," cut off from its psychiatric origin.

History and Evolution of Epilepsy Surgery

The surgical treatment for epilepsy has a worldwide historical relevance for centuries. There are archaeological reports that date it back to ancient Egypt; however, the year 1886 is considered a landmark in the surgical treatment for epilepsy in theModern Age, when the first surgery for the treatment of focal epileptic events was performed successfully. Since then, innumerable related articles have been published evoluonarily. Over the last centuries, new techniques and technologies provided better understanding, diagnosis and management for this disease. Thus, historical and evolutionary knowledge becomes important to let us better understand the current position of the surgery for epilepsy treatment and control.

Margiad Evans (1909-1958): A writer's epileptic experiences and their reflections in her work.

Margiad Evans, in the period 1930-1950, an acclaimed English writer, developed convulsive seizures at age 41 and died at age 50 from the tumor that had caused them. In her book "A Ray of Darkness", she describes in profound analytic detail her seizure experiences, especially the isolated auras that had preceded her first convulsion by many years. Their ultimate strangeness echoed a long-standing fascination by the indescribable, which is a recurrent theme in her literary work. Another aspect of her poetry, a focus on the experience of the moment that cannot be retained is likewise reminiscent of the volatility of her aura experiences. Of three texts that are presently being published posthumously, one ("The Nightingale Silenced") is a fragmentary continuation of her epileptic experience. She considered that she still had a lot to describe, contributing the inside of the "outside inside story" of epilepsy, clues on which neurology could work to obtain a deeper understanding. To have a focal motor seizure feels like being invaded by an alien force. An urge to run and heautoscopy are other recorded symptoms. Evans documents the experience of a long-lasting, predominantly nonconvulsive status epilepticus merging into aura continua where her earlier aura experiences appear transformed into a quasipsychotic state. But even in the account of "this appalling, this hellish condition", she is careful to maintain her high literary standards. Together, the two reports on her disease seem to represent the only comprehensive inside case history of epilepsy, a most valuable legacy.

Crisis epiléptica en la obra Transfiguración de Rafael Sanzio / Epileptic seizure depicted in The Transfiguration a work by Raphael Sanzio

Entre 1516 y 1520 Rafael Sanzio (1483-1520) realizó la obra Transfiguración. Es un cuadro de gran formato que representa un relato de los evangelios de Lucas, Mateo y Marcos con dos escenarios principales, el primero en la parte superior muestra la transfiguración de Cristo en el Monte Tabor; el segundo en la parte inferior expone la escena de un niño endemoniado que varios apóstoles intentan curar infructuosamente, lo cual solo ocurrió cuando Jesús lo hizo. Esta composición, en otras palabras, muestra un milagro fallido que no es habitual en el arte sacro. Un análisis desde la semiología neurológica permite aseverar que el niño poseído está presentando una crisis epiléptica tónica postural. Este artículo analiza la obra, la semiología neurológica en ella y su relación con la historia de la neurología

Raphael Sanzio (1483-1520) painted The Transfiguration between 1516 and 1520. It is a large format painting that illustrates two main scenes as described in the Gospel accounts of Luke, Mathew and Mark. The first scene, in the upper half, shows Christ ́s transfiguration on Mount Tabor; the lower half, shows the devil-possessed child with the apostles who had attempted unsuccessfully to heal him, but Christ heals the boy. In other words, this composition shows a failed miracle which is unusual in sacred art. Based on a neurological semiology analysis we can assert that the possessed boy is experiencing a tonic postural seizure. This article analyzes the painting, the neurological features depicted in it and its relationship with the history of neurology.

Evolution of concepts in epilepsy surgery.

At the time of the first meeting of the International League Against Epilepsy (ILAE) in 1909, surgical treatment for epilepsy had been accepted as an alternative therapy for over two decades, but was rarely practiced, considered a last resort for carefully selected patients. Localization was based on ictal semiology and identification of a structural lesion. Very few papers on epilepsy surgery were presented at ILAE meetings or published in Epilepsia during the first half of the 20th century. A modest explosion in interest in epilepsy surgery at mid-century resulted from recognition that "invisible" epileptogenic lesions could be identified by EEG, especially for temporal lobe epilepsy. Epilepsy surgery received a second boost in popularity toward the end of the 20th century with the advent of structural and functional neuroimaging, and the number of epilepsy centers worldwide doubled between the first Palm Desert conference in 1986 and the second Palm Desert conference in 1992. Neuroimaging also helped to increase application of surgical treatment to infants and young children with severe epilepsies. Epilepsy surgery was accepted as standard of care for drug-resistant focal epilepsy and was well-represented at international ILAE congresses and in Epilepsia. Advances continue into the 21st century with the introduction of laser ablation, and palliative neuromodulation approaches, which have greatly increased the population of patients who can benefit from surgery. Modern presurgical evaluation techniques have also made surgical treatment possible in many countries with limited resources. Three randomized control trials now have definitively proved the safety and efficacy of epilepsy surgery, however, this alternative therapy remains under-utilized even in the industrialized world, where less than 1% of potential candidates are being referred to epilepsy centers. Furthermore, those who are referred receive surgery an average of 20 years after onset of epilepsy, often too late to avoid irreversible disability. The major challenges in realizing the full potential of epilepsy surgery, therefore, are not as much in the continued improvement of the treatment itself, as they are in addressing the treatment gap that is preventing appropriate patients from being referred to full-service epilepsy centers.

Memórias póstumas da loucura mulata: as apropriações de Machado de Assis sob o corte patológico / Posthumous memoirs of mulatto insanity: a pathological interpretation of Machado de Assis's appropriations

Resumo Estudos para identificar eventuais relações entre a criação artística e a psicopatologia - desde o século XIX, na Europa - influenciaram o pensamento brasileiro acerca desse tema. O objetivo deste artigo, sob a óptica da história das ciências da saúde, consistiu em analisar as perspectivas, ao longo do século XX, segundo as quais as doenças neurológicas e psiquiátricas de Machado de Assis foram determinantes na criação e no conteúdo de suas produções literárias. A partir de um referencial teórico e metodológico baseado em Bakhtin, verificou-se que muitos autores consideraram a epilepsia de Machado de Assis o principal elemento responsável por seu ato criador, o que permitiu revisar a apropriação de diferentes teorias psiquiátricas no Brasil, assim como diversos conceitos teóricos.

Abstract Studies to identify possible relations between artistic creation and psychopathology (starting in nineteenth-century Europe) have influenced Brazilian thought on this topic. The objective of this article, from the perspective of the history of health sciences, is to analyze viewpoints throughout the twentieth century which considered the neurological and psychiatric diseases of Machado de Assis as fundamental to the development and content of his literary work. A theoretical and methodological reading based on Bakhtin found that many authors considered Machado de Assis's epilepsy to be the main reason behind his creativity, which allowed a review of the appropriation of different psychiatric theories in Brazil, as well as various theoretical concepts.

Désiré-Magloire Bourneville and his contributions to pediatric neurology.

Désiré-Magloire Bourneville ought to be thought of as the father of Pediatric Neurology for his significant contributions to the field. He worked as a physician, politician, writer, and editor. He was the first to describe the autosomal dominant genetic condition known as "tuberous sclerosis complex", after conducting an autopsy on a young female patient, where the main finding in the central nervous system was multiple dense tubers. The patient had refractory epilepsy and intellectual disability. His work was based on the study of epilepsy and idiocy, and he was also an advocate of public health and social medicine education; creating day hospital programs for children with this type of neurologic disease.

Historical perspective: The British contribution to the understanding of neurocysticercosis.

Neurocysticercosis, or brain infestation with the larval stage of Taenia solium, is the most common risk factor for epilepsy in many endemic regions of the world. Hardly any cases are seen in Western developed countries, including Britain. However, a sizeable number (n = 450) was seen among British soldiers returning from deputation to India, then a British colony, first reported by Col. MacArthur at the Queen Alexandria Military Hospital in 1931. Here, we review the influence of the perceptive observations of British Army medics on the understanding of the parasitic disorder. The majority of these people presented with epilepsy. Among the contributions of the army medics were establishing the diagnosis, initially by histological examination of subcutaneous and muscular infestation, and later by radiography, clarifying the prognosis and the role of medical and surgical treatments and uncovering the close relationship between the larval (cysticercosis) and adult (intestinal tapeworm) stages of T. solium.

Désiré-Magloire Bourneville and his contributions to pediatric neurology / Désiré-Magloire Bourneville y sus aportes a la neurología pediátrica

ABSTRACT Désiré-Magloire Bourneville ought to be thought of as the father of Pediatric Neurology for his significant contributions to the field. He worked as a physician, politician, writer, and editor. He was the first to describe the autosomal dominant genetic condition known as "tuberous sclerosis complex", after conducting an autopsy on a young female patient, where the main finding in the central nervous system was multiple dense tubers. The patient had refractory epilepsy and intellectual disability. His work was based on the study of epilepsy and idiocy, and he was also an advocate of public health and social medicine education; creating day hospital programs for children with this type of neurologic disease.

RESUMEN Désiré-Magloire Bourneville debería ser considerado como el padre de la Neurología Pediátrica por sus importantes contribuciones en este campo. Trabajó como médico, político, escritor y editor. Hizo las primeras descripciones de la condición genética autosómica dominante conocida como "Complejo de esclerosis tuberosa", después de realizar una autopsia en una paciente joven, en la que el principal hallazgo en el sistema nervioso central fueron múltiples lesiones tipo tubérculos. La paciente tenía epilepsia refractaria y discapacidad intelectual como síntomas asociados. Su trabajo se basó en el estudio de la epilepsia y la idiotez, a su vez fue un defensor de salud pública y la educación en medicina social; creando programas de hospital diurno para niños con diferentes tipos de enfermedades neurológicas.

The Montreal procedure: The legacy of the great Wilder Penfield.

Wilder Penfield pioneered the early practice of brain surgery. In binding together the disciplines of neurosurgery, neurology, neuropathology, psychology, and related basic sciences, Penfield transformed our understanding of the field of neuroscience. He brought to the operating room the meticulous techniques of Sherrington, combined with methods of stimulation described by Foerster, which he complemented with expert knowledge of the neurocytology of nervous tissue. While developing surgical treatments for epilepsy, Penfield began to map the brain. He established the "Montreal procedure" for the surgical treatment of epilepsy. His scientific contributions on neurostimulation were transformative in their time and continue to resonate today. This article reviews the life of Wilder Penfield and summarizes key scientific contributions. Specifically, we detail the Montreal procedure. We additionally present a painting by Canadian artist Iris Hauser, which purports to display the hidden treasures of the human mind.

What do Flaubert, Dostoevsky and Machado de Assis have in common with neurology? / O que Flaubert, Dostoevsky and Machado de Assis têm em comum com a neurologia?

ABSTRACT The Frenchman Gustave Flaubert, the Russian Fyodor Dostoevsky and the Brazilian Machado de Assis are known for their immeasurable contributions to literature. However, what most people do not know is that all three authors suffered from epilepsy and were affected by their neurological condition in different ways. We offer a short description of how epilepsy influenced their lives, how they dealt with it and how their neurological condition was present in their novels and correspondence. Their lives are excellent examples of how intimately neurology can be entwined in art and history, and provide an important perspective on patients with epilepsy.

RESUMO O francês Gustave Flaubert, o russo Fyódor Dostoevsky e o brasileiro Machado de Assis são conhecidos pela sua imensurável contribuição para a Literatura. No entanto, o que a maioria das pessoas desconhece é que os três autores sofriam de epilepsia e foram, de diferentes maneiras, afetados por sua condição neurológica. Nós fazemos uma breve descrição de como a epilepsia influenciou suas vidas, como eles lidaram com a doença e como sua condição neurológica estava presente em seus romances e correspondências. Suas vidas são excelentes exemplos de quão íntima pode ser a neurologia da arte e da história e fornecem uma importante visão sobre os pacientes com epilepsia.

Epilepsy and Neurosurgery: Historical Highlights.

Epilepsy has been known since antiquity and trepanation has been documented as a therapeutic option. The Greek born physician Aretaeus of Cappadocia (2nd century BC) was the first to recommend trepanation for the treatment of refractory epilepsy to drugs, pointing out the efficacy of the method (Fig. 1). Trepanation was practiced throughout the Middle Ages, as it is proved by the book of "Quattuor Magistri" and during Renaissance as well. In 19th century, Sir Victor Alexander Horsley (1857-1916), combining analysis of clinical presentation with cortical stimulation, performed a series of craniotomies for the treatment of epilepsy Fig. 2. In the following years the advent of electrophysiology and neurosurgery provided a fertile ground for further progress in epilepsy surgery such as the preoperative use of electroencephalography (EEG) to determine the epileptogenic zone by Otfrid Foerster (1873-1941); the research of Wilder Graves Penfield (1891-1976) in Montreal Neurological Institute and the use of stereoelectroencephalography (SEEG) by the neurosurgeon Jean Talairach (1911-2007) and the neurologist Jean Bancaud (1921-1994)) Fig. 3. Nowadays, epilepsy surgery remains a valuable therapeutic option in cases of drug resistant epilepsy.

[Brain X-radiation for Childhood Epilepsy, Hydrocephalus or Mental Retardation? Research at Tuebingen University, 1940-1946]. / Röntgenbestrahlung des Gehirns zur Behandlung von kindlicher Epilepsie, Hydrocephalus oder Schwachsinn? Forschungen an der Tübinger Universitätsklinik von 1940-1946.

Brain X-radiation for Childhood Epilepsy, Hydrocephalus or Mental Retardation? Research at Tuebingen University, 1940-1946 We reconstructed 65 cases out of a series of "experimental" X-ray-therapy by chart review and reanalysis of publications from a contextual historical perspective. The research procedures in the context of NS-pressure for effectiveness soon dismissed structured scientific procedures and surrendered own standards, whereas radiation impact did not transgress the contemporary guidelines.

Magnetoencephalography (MEG): Past, current and future perspectives for improved differentiation and treatment of epilepsies.

In addition to visual analysis digital computerized recording of electrical and magnetic fields by using EEG and MEG opened a new window for research concerning improved understanding of pathophysiology, diagnosis and treatment of epilepsies. In the last 25 years MEG was used more and more in clinical studies concerning localization of focal epileptic activity, functional cortex and network analysis. Simultaneous MEG/EEG recording and analysis offer the use of complimentary information increasing the sensitivity for tracing primary epileptic activity. Combined MEG/Stereo-EEG recordings showed that MEG noninvasively identified regional interictal networks. The current role of MEG for presurgical evaluation with regard to noninvasive localization in MRI normal patients, guiding of invasive electrode implantation and correlation to postoperative outcome after epilepsy surgery is stressed. Challenges and future opportunities for MEG in clinical epileptology are discussed.

Aliocha Dostoevski's death during an epileptic seizure / Morte de Aliocha Dostoiévski durante uma crise epiléptica

ABSTRACT Mortality due to epilepsy is of great concern worldwide. Individuals with epilepsy have a two- or three-fold risk of death when compared to the general population. Based on biographical data and Anna Grigoriévna Dostoevskaia’s memories, the authors concluded that a prolonged episode of status epilepticus was the culprit in the death of young Aliocha, youngest son of Fyodor Mikhailovich and Anna Dostoevski. At the time of Aliocha’s death, very limited knowledge about epilepsy or therapeutic resources was available. Despite all the progress, epilepsies remain potentially fatal conditions. The suffering generated by Aliocha’s death and other similar cases remains as a challenge for epileptologists who assemble efforts to fight against such conditions.

RESUMO Mortalidade por epilepsia configura uma grande preocupação mundial com seus portadores apresentando um risco de morte de duas a três vezes maior do que a população em geral. Os autores concluem, segundo dados biográficos e as memórias de Anna Grigoryevna Dostoyevskaia, mãe de Aliocha, o filho mais novo de Fyodor Mikhailovich Dostoievski, que uma crise prolongada de “status epilepticus” tenha sido a causa da morte do jovem Aliocha. Na ocasião de sua morte, pouco conhecimento havia disponível quanto à epilepsia e aos recursos terapêuticos. Apesar de todo o progresso, as epilepsias permanecem como condições potencialmente fatais. O sofrimento gerado pela morte de Aliocha e outros casos similares continua a ser um desafio para que epileptologistas juntem esforços contra esta condição.

Osteoporosis Associated with Epilepsy and the Use of Anti-Epileptics-a Review.

The increased rate of fractures associated with epilepsy has been long recognised but remains incompletely understood. Study quality and study results have varied, with some but not all studies showing bone diseases including osteoporosis and/or osteomalacia, and a high prevalence of vitamin D insufficiency and deficiency are also noted. Falls risk can also be higher in patients with epilepsy taking anti-epileptic medications, potentially leading to fracture. Larger research collaborations are recommended to further advance understanding in this field, particularly to examine underlying genetic and pharmacogenomic associations of epilepsy and anti-epileptic medication usage and its association with bone diseases and fractures, as well as further investigation into optimal management of bone health in epilepsy.

Disembodiment and Identity in Literary Depictions of Epilepsy Surgery.

This article explores the often perplexing experience of being an epilepsy surgery candidate, as portrayed in four book-length accounts: Laura Doermer's Moritz mein Sohn (Moritz my son, 1990), David B.'s L'ascension du haut mal (The ascent of the high evil, 1996; published in English as Epileptic, 2003), Ray Robinson's Electricity (2006), and Alberto Capitta's Il giardino non esiste (The garden doesn't exist, 2009). Building upon critical disability studies and the work of French poststructuralists Gilles Deleuze and Félix Guattari, I analyze issues of embodiment, identity and narrative (re)construction in the postsurgical alleviation of chronic illness. I argue that these texts highlight the inevitable disruption of self that brain surgery entails and ultimately resist biomedical normativization. They also call for a narratological reconsideration of current illness narrative typologies, among which Arthur Frank's "chaos narrative" emerges as the best suited to accommodate the chronic fragmentation of consciousness and voice in epilepsy.

The start and development of epilepsy surgery in Europe: a historical review.

Epilepsy has not always been considered a brain disease, but was believed to be a demonic possession in the past. Therefore, trepanation was done not only for medical but also for religious or spiritual reasons, originating in the Neolithic period (3000 BC). The earliest documentation of trepanation for epilepsy is found in the writings of the Hippocratic Corpus and consisted mainly of just skull surgery. The transition from skull surgery to brain surgery took place in the middle of the nineteenth century when the insight of epilepsy as a cortical disorder of the brain emerged. This led to the start of modern epilepsy surgery. The pioneer countries in which epilepsy surgery was performed in Europe were the UK, Germany, and The Netherlands. Neurosurgical forerunners like Sir Victor Horsley, William Macewen, Fedor Krause, and Otfrid Foerster started with "modern" epilepsy surgery. Initially, epilepsy surgery was mainly done with the purpose to resect traumatic lesions or large surface tumours. In the course of the twentieth century, this changed to highly specialized microscopic navigation-guided surgery to resect lesional and non-lesional epileptogenic cortex. The development of epilepsy surgery in Southern Europe, which has not been described until now, will be elaborated in this manuscript. To summarize, in this paper, we provide (1) a detailed description of the evolution of European epilepsy surgery with special emphasis on the pioneer countries; (2) novel, never published information about the development of epilepsy surgery in Southern Europe; and (3) we review the historical dichotomy of invasive electrode implantation strategy (Anglo-Saxon surface electrodes versus French-Italian stereoencephalography (SEEG) model).