Ulises en la literatura médica / Ulysses in the medical literatura

INTRODUCCIÓN: Es frecuente el empleo de manifestaciones culturales como origen de descriptores en el campo de las ciencias de la salud. La historia de Odiseo (Ulises) es una de las obras más antiguas e influyentes de la literatura universal y ha dado lugar a múltiples creaciones posteriores, con un fuerte arraigo en la cultura popular. OBJETIVO: Ponderar el uso del relato de Odiseo en la literatura médica, describir los términos en los que se emplea y discutir la pertinencia de estos. DESARROLLO: Tras una revisión en PubMed, se hallaron 112 publicaciones de carácter médico con referencias al mito de Odiseo, de un total de 343 resultados. Se recogen hasta cinco entidades diferentes directamente nombradas a partir de Ulises (tres síndromes de Ulises, el contrato de Ulises y el conflicto de Ulises), y dos más sobre otros personajes que forman parte de su ciclo (síndrome de Elpenor y síndrome de Penélope), las cuales analizamos de forma crítica respecto al material original del que se parte. CONCLUSIONES: La historia de Odiseo constituye una de las fuentes de inspiración más frecuentes en la medicina, tanto para la elaboración de descriptores como para el empleo de símiles, metáforas u otras figuras retóricas, particularmente en el área de las neurociencias

INTRODUCTION: Cultural manifestations are frequently used as a source of descriptors in the field of the health sciences. The story of Odysseus (Ulysses) is one of the oldest and most influential works of world literature and has given rise to many subsequent creations, with strong roots in popular culture. AIMS: To consider the use of the story of Odysseus in the medical literature, to describe the terms in which it is used, and to discuss its relevance. DEVELOPMENT: From a review performed in PubMed, 112 medical publications with references to the myth of Odysseus were found, out of a total of 343 results. Five different conditions named directly after Ulysses were found (three Ulysses syndromes, the Ulysses contract and the Ulysses conflict), together with two others that have been given the names of other characters who are part of the same cycle (Elpenor syndrome and Penelope syndrome), which we analyse in a critical manner referring to the original material from which they have been taken. CONCLUSIONS: The story of Odysseus constitutes one of the most frequent sources of inspiration in medicine, both for the creation of descriptors and for the use of similes, metaphors or other rhetorical figures, particularly in the area of neuroscience

Aliocha Dostoevski's death during an epileptic seizure.

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.

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.

A definition and classification of status epilepticus--Report of the ILAE Task Force on Classification of Status Epilepticus.

The Commission on Classification and Terminology and the Commission on Epidemiology of the International League Against Epilepsy (ILAE) have charged a Task Force to revise concepts, definition, and classification of status epilepticus (SE). The proposed new definition of SE is as follows: Status epilepticus is a condition resulting either from the failure of the mechanisms responsible for seizure termination or from the initiation of mechanisms, which lead to abnormally, prolonged seizures (after time point t1 ). It is a condition, which can have long-term consequences (after time point t2 ), including neuronal death, neuronal injury, and alteration of neuronal networks, depending on the type and duration of seizures. This definition is conceptual, with two operational dimensions: the first is the length of the seizure and the time point (t1 ) beyond which the seizure should be regarded as "continuous seizure activity." The second time point (t2 ) is the time of ongoing seizure activity after which there is a risk of long-term consequences. In the case of convulsive (tonic-clonic) SE, both time points (t1 at 5 min and t2 at 30 min) are based on animal experiments and clinical research. This evidence is incomplete, and there is furthermore considerable variation, so these time points should be considered as the best estimates currently available. Data are not yet available for other forms of SE, but as knowledge and understanding increase, time points can be defined for specific forms of SE based on scientific evidence and incorporated into the definition, without changing the underlying concepts. A new diagnostic classification system of SE is proposed, which will provide a framework for clinical diagnosis, investigation, and therapeutic approaches for each patient. There are four axes: (1) semiology; (2) etiology; (3) electroencephalography (EEG) correlates; and (4) age. Axis 1 (semiology) lists different forms of SE divided into those with prominent motor systems, those without prominent motor systems, and currently indeterminate conditions (such as acute confusional states with epileptiform EEG patterns). Axis 2 (etiology) is divided into subcategories of known and unknown causes. Axis 3 (EEG correlates) adopts the latest recommendations by consensus panels to use the following descriptors for the EEG: name of pattern, morphology, location, time-related features, modulation, and effect of intervention. Finally, axis 4 divides age groups into neonatal, infancy, childhood, adolescent and adulthood, and elderly.

The demise of Archbishop Wolf Dietrich--A historical note on a fatal status epilepticus documented at Salzburg in 1617.

INTRODUCTION: Wolf Dietrich of Raitenau (WD) ruled the archiepiscopal Salzburg from March 2nd 1587 to December 17th 1611. He was condemned by his successor Archbishop Markus Sittikus of Hohenems to spend his last years imprisoned at the Fortress Hohensalzburg, where he died on January 16th 1617. This historical note describes the causes of his death. MATERIALS AND METHODS: The original Latin handwriting, including the detailed medical history and the autopsy of the Archbishop's body performed by his personal physician, was analyzed in conjunction with historical handwritings provided by St. Peter's Abbey, Salzburg handwriting assigned to Markus Sittikus. RESULTS: Wolf Dietrich of Raitenau had his first well-documented left hemispheric stroke in winter 1604/05. He had palsy of his right arm, was unable to write, and, therefore, used a stamp instead of his signature until October 1605. After another stroke, right hemispheric in origin with persisting palsy of his left arm ["leva corporis pars iam pridem simili ex apoplectico assultu in paralysin resoluta"], he developed symptomatic epilepsy with recurring seizures ["epileptico insultu quo etiam alias correptus est"]. On January 15th 1617, he suffered from a secondarily generalized convulsive status epilepticus ["toto corpore convellitur epileptico insultu"] with stertorous breathing and distortion of his face ["spuma stertore insigni faciei perversione"] and was unconscious for 8h. He recovered from coma and showed dysphagia, buccofacial apraxia ["abolitam diglutiendi facultatem"], reversible speech disturbance ["accisa etiam verba loqui"], and left-sided hemiplegia ["leva corporis pars… immobilis prorsus est reddita"]. The following day, he had speech disturbances, and he died at noon. His autopsy showed large but intact liver ["hepar magnum sanum"] and heart ["cor magnum in quo lapsus nullus"]. There was intrapulmonal mucus ["pituita imbutus"], and part of the lungs adhered to its pleura. He had five kidney stones and a partly cirrhotic spleen. The cause of his death was assumed to be intracerebral ["causa mortis in capite requienda fuisset"]. DISCUSSION: The terminal suffering of Wolf Dietrich of Raitenau is the first witnessed case report on a fatal status epilepticus in Salzburg. Most likely, he suffered from vascular epilepsy due to a right hemispheric stroke, leading to status epilepticus with left-sided Todd's palsy and speech disturbances. An acute symptomatic etiology of this disease cannot be ruled out, as for religious reasons, the Archbishop's brain was not autopsied. CONCLUSION: Meticulous medical reporting including autopsy was already available in Salzburg in 1617, and the symptomatic etiology of epilepsy was diagnosed correctly. This article is part of a Special Issue entitled "Status Epilepticus".

Historical vignette: medical treatment of status epilepticus.

The treatment of status epilepticus has changed over the past five decades since the first colloquium on status epilepticus, held in Marseille in 1962. New intravenous drugs, such as valproate, levetiracetam, lacosomide or ketamine and new routes of administration, such as intranasal or bucal, as well as high-class randomized clinical trials in the prehospital setting and early stages of status have changed the field. However it is remarkable, how the basic principles and difficulties of treatment of status epilepticus have remained the same. This article is as a translation of a narrative review authored by Dieter Janz at the Marseille Colloquium 1962, published in 1967. The medical practice and all available treatment at that time have been reviewed critically in the article. The translation of the original French article has been kept as close as possible to the original, to give a detailed account on the treatment of status at that time.

The historical evolution of, and the paradigms shifts in, the therapy of convulsive status epilepticus over the past 150 years.

The evolution of the treatment of convulsive status epilepticus since the mid- nineteenth century is outlined. Therapy has been advanced not only by the use of new drugs, but also by advances in the approach to therapy. The major pharmacologic developments were the introductions of bromide, anesthetics, barbiturate, phenytoin, paraldehyde, chlormethiazole, and the benzodiazepines. Throughout this period, the emphasis of therapy was on "sedation" and anesthesia, and the development of technologies for safe anesthesia in the postwar years were an important step. Since 1970, changes to the approach to therapy have been more important than any pharmacologic advance, and it is only recently that new drugs have been introduced into the therapy of status epilepticus. We may now be on the threshold of significant new paradigm shifts.

[Nonconvulsive status epilepticus in comatose adults]. / Estado epiléptico no convulsivo en adultos en coma.

INTRODUCTION: Nonconvulsive status epilepticus (SE) is a term used to denote a range of conditions in which electrographic seizure activity is prolonged and results in nonconvulsive clinical symptoms. Nowadays, some experts on nonconvulsive SE have emphasized the utility on the clinical practice to consider the classification taking in account both the clinical setting and the severity of consciousness impairment, differentiating between ambulatory patients (from almost normal mental state to stupor) which includes absence SE and complex partial SE; and nonconvulsive SE in coma. AIM: To review the literature in relation to the diagnosis of nonconvulsive SE in comatose and/or critically ill patients. DEVELOPMENT: Nonconvulsive SE has been reported with surprising frequency in a wide variety of acute neurological processes such as cerebrovascular disease, anoxia, subarachnoid hemorrhage, cranial trauma, encephalitis and following convulsive SE. CONCLUSIONS: Nonconvulsive seizures and episodes of nonconvulsive SE in patients with severe impairment of consciousness are frequent and, therefore, continuous EEG monitoring is an essential neurophysiologic tool in the evaluation of comatose subjects. EEG interpretation in patients with nonconvulsive SE may be particularly difficult and problematic and, therefore, requires expert knowledge and a clinical and neurophysiologic specific training.

The history of status epilepticus and its treatment.

Despite the fact that status epilepticus was been recognized since antiquity, its existence was largely ignored until the mid-nineteenth century. In this review we cover the medical literature of status epilepticus from the late nineteenth century until the early 1970s when the modern era of status epilepticus began. We pay particular attention to the impact of the ILAE and its principal members on the understanding and awareness of status epilepticus. We also cover the evolution of treatment regimens advocated for status epilepticus from the late nineteenth century to the early 1970s when the benzodiazepines were established as first line treatments.

Historical aspects of critical care and the nervous system.

The appropriate starting point for a history of neurocritical care is a matter of debate, and the organization of facts and conjectures about it must be somewhat arbitrary. Intensive care for neurosurgical patients dates back to the work of Walter Dandy at the Johns Hopkins Hospital in the 1930s; many consider his creation of a special unit for their postoperative care to be the first real ICU. The genesis of neurocritical care begins in prehistory, however. This article gives a predominantly North American history, with some brief forays into the rest of the world community of neurointensivists.

The intriguing case of Christina the Astonishing.

Spiritual explanations for epilepsy have existed since antiquity and continue to be prevalent in some communities today. While the vast majority of the unfortunate recipients of this understanding are thought to be possessed by evil forces, a few are deemed to be special vessels for divine communication. Here we present the intriguing case of Christina the Astonishing (1150-1224). Christina appears to be unique in the archives of the religious interpretation of epilepsy in that her seizures were understood to represent her willing submission to demonic torments to provide much needed respite for those in purgatory. Thus she provides an ingenious link between the demonic and divine explanations of the disorder. From a medical perspective, the analysis of contemporary accounts of her afflictions provide compelling evidence of status epilepticus, olfactory auras, and probable frontal lobe epilepsy, with frequent secondary generalization. Even more remarkably, the 13th century accounts of Christina's shame and embarrassment and the social stigma associated with her seizures strike a startling contemporary chord.

A diary of epilepsy in the early 1800s.

This article describes the diary of a man from 19th-century England (1829-1834) that documents the onset and course of his wife's epilepsy after a stroke. Her stroke produced aphasia and right hemiparesis, but her epilepsy was the diary's focus and caused the greatest concern. The diary documents the history of her epilepsy in detail. In addition to tonic-clonic seizures, she experienced frequent bouts of status epilepticus and complex partial seizures. The diary contains some of the earliest recorded descriptions of status epilepticus and its aftermath of delirium, mood disorder, and hysteria. It also offers some of the earliest and most detailed accounts of complex partial seizures. Bleeding by cupping was the only symptomatic or prophylactic treatment recorded. These aspects of the diary are presented, as are the historical perspectives on epilepsy, including early beliefs and stigmas, therapeutic remedies, and early European views of epilepsy.

A semiological classification of status epilepticus.

The classification of status epilepticus (SE) has been a subject of discussion for many years, yet no satisfactory agreement has been reached. Due to their complexity, status episodes often defy classification according to the current international classification scheme. The semiological seizure classification (SSC) has been in use in several epilepsy centers for more than a decade, and has proven to be a valid approach to the classification of epileptic seizures. Based on the detailed analysis of more than 100 episodes of SE documented with video-EEG recordings, the authors now present a proposal for a semiological classification of status epilepticus (SCSE). The SCSE reflects the assumption implied by all modern definitions of SE that "there are as many types of status as there are types of seizures" and relies on the same principles as the SSC, focusing on the main clinical manifestations and the evolution of the status episode. The clinical manifestations of SE are subdivided into semiological components and classified along three axes: the type of brain function predominantly compromised by the seizure activity, the body part involved, and the evolution over time. Each axis contains several subcategories, so that many different levels of accuracy are possible. The SCSE, just like the SSC, is meant to be part of a comprehensive epilepsy classification which classifies as independent variables (epileptogenic zone, ictal semiology, etiology, related medical conditions) the main features of the patient's epilepsy, allowing for each variable maximum flexibility.

Phineas Gage, ‘Tan’ y la importancia de los casos clínicos / Phineas Gage, ‘Tan’and the importance of case reports

Introducción. Las descripciones originales de la lesión frontal de Phineas Gage (1848) y del tumor de crecimiento lento de ‘Tan’, el famoso paciente de Broca (1861), son ejemplos de cómo un sencillo caso clínico puede enseñar valiosas lecciones, algunas de ellas discutidas todavía siglo y medio después. Desarrollo. En este artículo se revisan y resumen las fuentes originales de estos dos casos primigenios, en Boston y París. Se analizan las lecciones que estos dos pacientes dejaron sobre la localización de funciones cerebrales y se ubican en el contexto de la moderna medicina basada en evidencias

Introduction. The original descriptions of the frontal lobe injury of Phineas Gage (1848) and the slowly growing tumor of ‘Tan’, Broca’s famous patient (1861), are examples of how a simple case report can teach important lessons, some of them still discussed a century and a half later. Development. In this article, the original sources of both of these seminal cases, in Boston and Paris, have been reviewed and are briefly summarized. The lessons learned from them in the effort to localize brain functions are explained and set in the context of modern evidence-based medicine