Francisco de Goya and the Seizing Impenitent.

The painting, St. Francis and the Dying Impenitent (1788) by the Spanish Baroque painter, Francisco Goya, is discussed by the author within the context of epilepsy and biographical events in the lives of both the saint and the painter.

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.

The earliest experimental convulsions by Joseph Priestley in 1766 friendship with Benjamin Franklin.

In 1766, Joseph Priestley (1733-1804) was the first to systematically demonstrate the universal convulsive effect of an electrical discharge applied to the head of all the several species studied. We here republish his overlooked experiments, which often resulted in death, and which ante date the scientific studies of the electrical functions of the brain, the role of "discharges" in seizures, and experimental epilepsy by about a century. Priestley's studies of electricity were influenced by those of Benjamin Franklin (1706-1790), who became a good friend during Franklin's prolonged period in London between 1757 and 1775. Both were elected Fellows of the Royal Society and both were awarded the Copley Medal of that Society. Priestley's experiments are relevant to the history of epilepsy and neuropsychiatry, and to the modern study of sudden unexplained death in epilepsy (SUDEP).

'Infantile convulsions' in the early nineteenth century. Abnormal brain blood flow and leeches, teething and gums' scarification and food and purgatives: the historical contribution of John Clarke (1760-1815).

In this article, we discuss on the role of the British physician and midwifery practitioner John Clarke (1760-1815) in the characterisation of the various types of seizures and epilepsy and related phenomena ('convulsions') occurring in children. In his unfinished work Commentaries on Some of the Most Important Diseases of Children (1815), Clarke discussed the pathophysiology of convulsions and was the first to describe, 12 years before the French neurologist Louis Francois Bravais (1801-1843) and more than 30 years before the Irish-born physician Robert Bentley Todd (1809-1860), the postictal paresis. He believed that convulsions originated from changes in pressure within the ventricles as a consequence of abnormal blood flow to the cerebral vessels. In keeping with the theories of his time (e.g. Baumes 1789, 1805; Brachet 1824), Clarke believed that teething was a major cause of 'infantile convulsions'. His proposed remedies ranged from scarification of the gums to ammonia, application of leeches, cold water, and purgatives. The use of antispasmodics, quite popular at the time, was instead questioned. In his Practical Observations on the Convulsions of Infants (1826), the London practitioner and midwifery John North (1790-1873) deeply criticised Clarke's view that convulsions arise inevitably as a consequence of organic brain lesions. North inferred that the results of autopsies of children who had died of convulsions revealed no brain damages, and claimed that cerebral irritation could also occur as the effect of distant lesions. Other Clarke's contemporaries (e.g. Jean Baptiste Timothée Baumes-1756-1828) inferred that all convulsions reflected a hereditary diathesis, which rendered children (especially those with softer and limper nervous and muscular tissues!) extremely sensitive to all sorts of provocation that could trigger convulsions, including bad digestion (more pronounced at the time of teething), loud noise, and bright light. Although almost every aspect of Clarke's view on convulsions was subsequently proved wrong, his (and his contemporaries') work provides fascinating insights into the theories and therapies of seizures, which were popular at the dawn of modern neurology.

A brief history of typical absence seizures - Petit mal revisited.

In this article, we have traced back the history of typical absence seizures, from their initial clinical description to the more recent nosological position. The first description of absence seizures was made by Poupart in 1705 and Tissot in 1770. In 1824, Calmeil introduced the term "absences", and in 1838, Esquirol for the first time used the term petit mal. Reynolds instead used the term "epilepsia mitior" (milder epilepsy) and provided a comprehensive description of absence seizures (1861). In 1854, Delasiauve ranked absences as the seizure type with lower severity and introduced the concept of idiopathic epilepsy. Otto Binswanger (1899) discussed the role of cortex in the pathophysiology of "abortive seizures", whereas William Gowers (1901) emphasized the importance of a detailed clinical history to identify nonmotor seizures or very mild motor phenomena which otherwise may go unnoticed or considered not epileptic. At the beginning of the 20th Century, the term pyknolepsy was introduced, but initially was not universally considered as a type of epilepsy; it was definitely recognized as an epileptic entity only in 1945, based on electroencephalogram (EEG) recordings. Hans Berger, the inventor of the EEG, made also the first EEG recording of an atypical absence (his results were published only in 1933), whereas the characteristic EEG pattern was reported by neurophysiologists of the Harvard Medical School in 1935. The discovery of EEG made it also possible to differentiate absence seizures from so called "psychomotor" seizures occurring in temporal lobe epilepsy. Penfield and Jasper (1938) considered absences as expression of "centrencephalic epilepsy". Typical absences seizures are now classified by the International League Against Epilepsy among generalized nonmotor (absence) seizures.

Ancient Indian concepts about phenomenology, biology, and therapeutics of epilepsy.

This article discusses etiology, pathogenesis, symptoms, and treatment of epilepsy, as described in Charaka Samhita (translation: Charaka's Compendium) and Sushruta Samhita, the two core texts of Ayurveda, an ancient system of medicine. Ayurveda emphasized amnesia and loss of consciousness as core features of epileptic seizures (Sanskrit: apasmar; translation: apa negation, smaran memory) and recognized that seizures occur due to a disturbance in brain function or flow of "humors" to the brain. Semiology of various seizure types was well described. Epilepsy was attributed to both internal and multiple exogenous factors. Treatment of epilepsy with formulations of naturally occurring substances, their compounding and use, is described in remarkable detail. Lifestyle modifications to protect people with epilepsy are also documented. Cognitive comorbidities of epilepsy were recognized. Although none of the Ayurveda formulations have any empirical evidence supporting their safety or efficacy in the treatment of epilepsy, studies are needed to generate relevant evidence, to recognize their hazards, and to integrate traditional and complementary systems of medicine with modern health care in an informed and safe manner.

Epilepsy and metaphors in literature.

This topic has two different aspects: seizures and epilepsy used as metaphors and seizures described in metaphors. Whereas some metaphors are unique and have high literary value, others can be categorized in prototypical groups. These include sexual metaphors; metaphors of strong emotions, of life crises and breakdown, and also of exultation; religious metaphors; and metaphors of weakness which mostly belong to older literature. Writers with epilepsy, in their literary texts, rarely talk about seizures in metaphors. Authors who do this sometimes seem to use reports that they have received from afflicted persons. The most common metaphors for seizures belong to the realms of dreams and of strong sensory impressions (visual, auditory). More rarely, storm and whirlwind are used as literary metaphors for seizures. This article is part of a Special Issue entitled "Epilepsy, Art, and Creativity".

Epilepsy on the silver screen in the 21st century.

Epilepsy remains an attractive vehicle for filmmakers in the twenty-first century. This review examines the themes of twenty-one films, released between 2000 and 2014, that feature a character with epilepsy or a pivotal scene involving a seizure. Epilepsy continues to be associated with the supernatural in modern cinematic output. Demonic possession and epilepsy now share a similar cinematic lexicon. Unfortunately, the overlap is more than just visual. Supernatural treatments of narratives that claim to be 'based on a true story' of someone with epilepsy continue to blur the lines between medical and spiritual realms. Although there has been a steady progression away from concealment of the condition, epilepsy continues to signal 'otherness' in movie characters and seldom in a good way. All too often, a character has epilepsy to maximize the unease of the audience with them; it is a device that is used to signal 'this character is not like you'. However, amongst the hackneyed negative stereotypes, accurate portrayals of the condition are beginning to emerge, not least due to active collaborations between filmmakers and epilepsy advocacy groups. Far from being worthy, it is heartening that these films are also those that are the most absorbing and thought-provoking of the cinematic output thus far this century. This article is part of a Special Issue entitled "Epilepsy, Art, and Creativity".

Representations of epilepsy on the stage: From the Greeks to the 20th century.

Epilepsy is a disorder that has been used by dramatists in various ways over the ages and therefore highlights the views of the disorder as people saw it at the time the plays were written and performed. In the 6th century BC, links between tragedy and epilepsy were developed by Greek playwrights, especially Euripides, in Iphigenia among the Taureans and Heracles where epilepsy and madness associated with extreme violence occur together. Both Heracles and Orestes have episodes after a long period of physical exhaustion and nutritional deprivation. During the Renaissance, Shakespeare wrote plays featuring different neurological disorders, including epilepsy. Epilepsy plays a crucial part in the stories of Julius Caesar and Othello. Julius Caesar is a play about politics, and Caesar's epilepsy is used to illustrate his weakness and vulnerability which stigmatizes him and leads to his assassination. Othello is a play about jealousy, and Othello, an outsider, is stigmatized by his color, his weakness, and his 'seizures' as a form of demonic possession. In modern times, Night Mother portrays the hard life of Jessie, who lives with her mother. Jessie has no friends, her father has abandoned the family, and she has no privacy and is ashamed. Stigma and social pressures lead her to commit suicide. Henry James' novella, The Turn of the Screw, portrays a governess with dream-like states, déjà vu, and loss of temporal awareness who has been sent to the country to look after two small children and ends up killing one. This novella was turned into an opera by Benjamin Britten. Most recently, performance art has been portraying epilepsy as the reality of a personally provoked seizure. Both Allan Sutherland and Rita Marcalo have purposely provoked themselves to have a seizure in front of an audience. They do this to show that seizures are just one disability. Whether this provokes stigma in audiences is unknown. Whether the performance artists understand the potential for status epilepticus has not been discussed. This article is part of a Special Issue entitled "Epilepsy, Art, and Creativity".

[Electroconvulsive therapy and level of evidence: From causality to dose-effect relationship]. / Électroconvulsivothérapie et niveau de preuve : de la causalité à la relation dose-effet.

OBJECTIVES: The first objective of this article is to summarize the history of electroconvulsive therapy (ECT) in psychiatry in order to highlight the transition from clinical level of evidence based on phenomenological descriptions to controlled trial establishing causal relationship. The second objective is to apply the criteria of causation for ECT, to focus on the dose-effect relationship criteria, and thus to analyze the conditions of application of these criteria for ECT. METHODS: A literature review exploring the use of electricity, ECT and electroencephalography (EEG) in psychiatry was conducted. The publications were identified from the Pubmed and GoogleScholar electronic databases. The scientific literature search of international articles was performed in July 2016. RESULTS: In 1784, a Royal commission established in France by King Louis XVI tested Mesmer's claims concerning animal magnetism. By doing that, the commission, including such prominent scientists as the chemist Anton Lavoisier and the scientist and researcher on electricity and therapeutics Benjamin Franklin, played a central role in establishing the criteria needed to assess the level of evidence of electrical therapeutics in psychiatry. Surprisingly, it is possible to identify the classical Bradford Hill criteria of causation in the report of the commission, except the dose-effect relationship criteria. Since then, it has been conducted blinded randomized controlled trials that confirmed the effectiveness of ECT against ECT placebos for the treatment of psychiatric disorders. At present, the dose-effect relationship criteria can be analyzed through an EEG quality assessment of ECT-induced seizures. CONCLUSIONS: EEG quality assessment includes several indices: TSLOW (time to onset of seizure activity ≤5Hz, seconds), peak mid-ictal amplitude (mm), regularity (intensity or morphology of the seizure (0-6)), stereotypy (global seizure patterning, 0-3) and post-ictal suppression (0-3). A manual rating sheet is needed to score theses indices. Such manual rating with example of EEG segments recording is proposed in this article. Additional studies are needed to validate this manual, to better establish the dose-response relationship for the ECT, and thus strengthen the position of the EEG as a central element for clinical good practice for ECT.

[Jackson's theories on the nature of motor symptoms].

Of John Hughlings Jackson's many contributions to neurological symptomatology, three motor symptoms serve as illustrations of his greatness: convulsions beginning unilaterally with the "march of spasms" (later called Jacksonian epilepsy), tetanus-like seizures (later called Jacksonian cerebellar fits), and cerebellar attitude (later absorbed into the category of "decerebrate rigidity"). The author has summarized their clinical characteristics and the underlying pathophysiological mechanisms as originally described by Jackson. His unique theory of "amicable antagonism" between the cerebrum and the cerebellum is also discussed. This dynamic concept can be considered a forerunner of theories of "rivalry" between higher brain centers.

Differentiation between seizure and hysteria in a tenth-century persian text: Hidayat of al-Akhawayni (d. 983 AD).

Although hysteria is associated largely with the nineteenth century, we find the subject treated in a tenth-century Persian medical text, the Hidayat al-Muta`allemin Fi al-Tibb [A Guide to Medical Learners] by al-Akhawayni Bukhari (d. 983 AD), a prominent physician in the Persian history of medicine. In this article, we discuss al-Akhawayni's views on seizure and hysteria and his differentiation between the two conditions, and we place it in a historical context.

Possessed by evil spirits: a history of seizures in infancy.

For 4 millennia, seizures in infancy were believed to be of supranatural origin and were dealt with by incantations, exorcising rituals, and protective amulets. Instead of pursuing scientific research into their causes, gods, devils, mothers, wet nurses, midwives, or obstetricians were blamed. Help from protective gods and patron saints was sought, and amulets against the "evil eye" were recommended by physicians, mostly in the form of necklaces. Infants were despised and hidden away from the community. Among the medical conditions associated with seizures, those most prominent were dentition, gastrointestinal irritation, and "bad" mother's milk. Medical treatment consisted of cutting or rubbing the gums with a hare's brain during dentition, and applying peony or theriac. Even during the 20th century, when laboratory methods, electroencephalography, brain imaging, and powerful pharmaceutical techniques were available, effective treatment evolved empirically rather than systematically.

[Epilepsy in films. A new century and the same old perspective?]. / La epilepsia en el cine. Un nuevo siglo y... una misma perspectiva?

INTRODUCTION: Epilepsy is a neurological pathology often represented in film. The literature on the subject concludes that the image of the disease is laden with sensationalism and imbued with stereotypes such as madness or possession. DEVELOPMENT: We provide a descriptive analysis of the seizures that appear in 155 film and analyze whether productions of the new century have succeeded in changing earlier impressions. In our series, the percentage of seizures that are not epilepsy (pseudoseizures and induced symptomatic seizures) reaches 37%. The analysis by age of seizure type and etiology of these shows similar results to the true population, however it should be noted that the age distribution of the sample does not match the true population. CONCLUSIONS: Epilepsy has not shed the spiritual component that traditionally accompanies it and that seizures tend to be used as simple visual aids, without excessive diligence in its correct representation and without much reference in the plot to the disease that causes them. However, in the last decade stigmas associated with this disease such as insanity, uncontrolled violence or victimization tend to normalize.

TITLE: La epilepsia en el cine. Un nuevo siglo y... una misma perspectiva?Introduccion. La epilepsia es una patologia neurologica ampliamente representada en el cine. En las publicaciones sobre el tema, se concluye que la imagen de la enfermedad aparece cargada de sensacionalismo e impregnada de estereotipos como la locura o la posesion. Desarrollo. Se realiza un analisis descriptivo de las crisis que aparecen en 155 peliculas y se comprueba si las producciones realizadas en el nuevo siglo han conseguido modificar las impresiones previas. En nuestra serie, el porcentaje de crisis que no constituyen epilepsia (pseudocrisis y crisis sintomaticas provocadas) alcanza el 37%. El analisis por grupos de edad del tipo de crisis y su etiologia muestra resultados similares a los reales; sin embargo, debe tenerse en cuenta que la distribucion etaria de la muestra no coincide con la de la poblacion real. Conclusiones. La epilepsia no consigue desprenderse del componente espiritual que tradicionalmente la acompaña, y las crisis suelen utilizarse como simple apoyo visual, sin excesivo celo en su correcta representacion y sin demasiado interes argumental en la enfermedad que las provoca. No obstante, en la ultima decada parecen normalizarse algunos estigmas, como la locura, la violencia descontrolada o el victimismo, que se asociaban a esta enfermedad.