Views & Reviews

Editor convidado:
Journal of LUCIANO DE PAOLA
Epilepsy and
Clinical
Neurophysiology
J Epilepsy Clin Neurophysiol 2004; 10(4):229-232

Epilepsy Across Space and Time: From Ancient History

to Current Beliefs – A Brief Review
Francisco M. B. Germiniani*, Ana C. Crippa**, Eduardo R. Pereira***, Carlos Silvado****,
Luciano De Paola*****
Hospital de Clinicas Epilepsy Program – Federal University of Paraná, Brazil

ABSTRACT
From time to time History and Medicine intersect, as anthropological discoveries try to understand past
medical practices. Epilepsy, as well, as other diseases is often referenced in ancient texts and rituals, and
later in books from the Middle Ages onwards. Contrary to other diseases, epilepsy has attracted more attention
throughout the ages, in part due to its overt clinical manifestations, namely convulsive seizures. The history
of epilepsy literally spans millennia, and accounts of epilepsy can be found as far as Babylonian times. More
specifically, the Sakkiku cuneiform appears to be the earliest written record, dated some 700 years BC. If
that holds true, men have been writing about epilepsy for close to 3000 years. The following (brief) review
acknowledges some of these efforts, merging from curious, haunting or astonishingly accurate, considering
the resources at each given time.
Key words: epilepsy, epilepsy history, cultural aspects in epilepsy.

RESUMO
Epilepsia através do tempo e espaço: da história antiga até conceitos atuais – uma breve revisão
Periodicamente fica evidente a intersecção da História e da Medicina, na medida em que novas descobertas
antropológicas desvendam antigas práticas médicas. Epilepsia, como outras doenças, sofre freqüente alusão
em textos antigos, rituais e livros a partir da Idade Média. O interesse deve-se, possivelmente as suas mani-
festações mais exuberantes, especificamente, as crises convulsivas. A história da epilepsia atravessa milênios
e pode ser traçada desde tempos babilônicos. De fato, a escrita Sakkiku, cuneiforme parece ser a mais antiga
forma de documentação escrita, datando de 700 anos antes da Era Cristã. Se verdadeira esta premissa, a
humanidade vem escrevendo sobre epilepsia ao longo dos últimos 3000 anos ou perto disto. Esta (breve)
revisão reconhece parte desta contribuição, que se mostra por vezes curiosa, outras assustadora e
freqüentemente impressionantemente precisa, considerando os recursos de conhecimento e técnicos dispo-
níveis em cada época descrita.
Unitermos: epilepsia, história da epilepsia, aspectos culturais em epilepsia.

* Neurologist.
** Clinical Neurophysiologist. Neuropediatrician. Assistent Professor of Neurology, Clinical Neurophysiologist.
*** Neurology Resident.
**** Neurologist. Clinical Neurophysiologist. Assistent Professor of Neurology.
***** Neurologist. Clinical Neurophysiologist.
Received Oct 18, 2004; accepted Nov 12, 2004.

229
 Germiniani F, Crippa A, Pereira E, et al.
EPILEPSY ACROSS TIME: INTERESTING
CONCEPTS SURROUNDING THE
“SACRED DISEASE”
Epilepsy, and convulsive seizures in particular, has
often been misinterpreted as a supernatural manifestation
in both old and current, Western and Eastern cultures.
Records of epilepsy trace back to Babylon(1,4), where a
person suffering from epilepsy was considered to be
possessed by a demon, which supposedly left the person’s
body at the end of a seizure. There were specific demons
for different types of seizures (gelastic, nocturnal, auto-
matisms, convulsive, and so on), reflecting the knowledge
of doctors from that time of varying semiology and seizure
types. There was even a verb, “Sibtu”, that meant either
“to be obsessed” or “to seize”.
In Asia, China has its first records of epilepsy in the
8th century, with medical manuscripts referring to epilepsy
as “Dian” (or “Xian” in other texts), a word that meant
“falling sickness”, or more properly, “convulsion”(1).
Ancient India(2) had one of the oldest medical systems
ever recorded and Indian doctors could distinguish up to
four different types of epilepsy, according to changes in
the humors, or “Doshas”, that controlled body function.
The word used to describe epilepsy was “Apasmara”,
that can be broken down in two different components:
“Apa”, a negation term, and “Smara”, which meant
“consciousness”. Texts from that period recommended that
the affected individual should pursue a dietary regimen
and avoid going to areas considered dangerous for risk of
injuries.
In what would later be known as the Western world,
the Roman games provided a possible cure for epilepsy(3).
The blood or liver of gladiators killed in the Roman games
should be consumed as a remedy for epilepsy. This practice
possibly had its roots in Etruscan funeral rites, where the
blood of a fallen warrior could transmit his strength to
others. The Greeks, prior to the Roman ascension, referred
to epilepsy in Hippocrate’s “The Sacred Disease”, a text
in which Hippocrates postulates that epilepsy was a
disorder of the brain(4). This idea was later discarded,
resurfacing only in the 18th and 19th centuries.
As the Roman Empire fell and the Medieval System
emerged, leading to the period known as the Middle Ages,
Christendom spread across Europe, epilepsy was once again
attributed to demonic possession. Even the Bible, in the
New Testament, made reference to this belief(5). In the
Gospel of Mark, in the “lunatic’s” passage, Jesus casts out
a “spirit” ordering it to leave the body of a young boy
suffering from seizures. Later, in the same passage, when
Jesus is inquired by His followers why they could not have
performed the same task when attending the boy, Jesus
replied that “This kind came out by nothing but prayer
230
and fasting”. This was later interpreted by some authors
as a possible mention that fasting – and in modern times
it’s equivalent, the ketogenic diet – was considered a
treatment option for epilepsy at the time. Other authors
rebuke this assumption, citing divergent translations of the
Bible and also that Jesus was supposedly recommending
that the apostles themselves should pray and fast if they
wished to perform the same cure.
Through the Middle Ages, the treatment of most
diseases was mired in supernatural concepts. Once again
many diseases resulted from divine punishment or inter-
vention and/or possession by supernatural forces (evil
spirits or the Devil). Thus, penance, praying and suppli-
cation to saints, as well as exorcisms, became part of the
therapeutic methods of that time. Saints had the power to
cure the faithful from different illnesses, epileptic attacks
included. To that effect, Saint Valentine, whose patron
day is February the 14th, became the Patron Saint
of epilepsy(5). There’s some controversy as to Saint
Valentine’s identity, as there were two martyrs who share
the title, one a Roman presbyter, the other a bishop of
Terni, Italy. Nevertheless, it seems that they could be the
same person and there’s reference to Saint Valentine,
regardless of which, curing an epileptic. Amidst his
patronage were both animal and human diseases, including
fainting, madness and epilepsy. A votive painting of Saint
Valentine can be found in the church of the Annunciation
of the Virgin Mary, in Croatia. In that portrait, Saint
Valentine is depicted with his eyes gazing upwards, as if
calling for divine assistance. At his feet are two people:
one an unconscious man foaming at the mouth, the other
a woman in what appears to be an ongoing seizure, with
eyes rolled up and tongue sticking out.
Across the Ocean, in pre-Columbian America, the
Incan Empire flourished and thrived, becoming the largest
civilization South of the Equator. Although Medicine was
highly developed, little documentation on their knowledge
of neurological diseases survived(6). The Incan term for
“Sonko-Nanay” could be split in its components. “Sanko”
meaning both the center of the human body and the mind,
located in the precordial region and upper abdomen; and
“Nanay”, which meant disease: thus the whole word meant
a lesion of the mind or paralysis. Variations of the word
were used for describing different symptoms, such as
absence and tonic-clonic seizures and even sudden death.
The later could possibly represent the first account of a
particular condition, known by the acronym SUDEP
(sudden unexplained death in epilepsy). Incan royalty was
not spared, as the wife of the last Incan ruler, Chimbo
Mama Cava, suffered from epilepsy. One of her seizures
was depicted in a conqueror’s drawing, showcasing her in
a resting position, with flexed arms, pursed lips and rolling
eyes. Once again myth played a role in explaining the
 Epilepsy across space and time: from ancient history ...
cause of epilepsy as some seizures could be the result of
avenging ancestors.
EPILEPSY ACROSS CULTURES:
COMMONALITIES AND DISTINGUISHED
PERSPECTIVES
Even though civilization as a whole progressed over
time, still nowadays some countries and cultures believe
that epilepsy is caused by outside sources. In Haiti, where
Voodoo priests still conduct ritual healings, epilepsy is
considered to be the result of possession by “loas”,
specifically “Marinnette”(7). In one report, a patient
presumably possessed by this entity suffered burns during
a seizure and was later proved to be suffering from tempo-
ral lobe epilepsy with bilateral foci. In Africa, some people
in certain areas believe that epilepsy is contagious and
sometimes avoid contact with people while they are having
a seizure.
Recently, an American journalist, Anne Fadiman,
published both a book and an article, aptly named “The
spirit catches you and you fall down”(8), focusing in the
beliefs of Laos immigrants living in the United States. In
the article she reports the case of a Hmong (ethnic group
from Laos) girl who suffered from Lennox-Gastaut
Syndrome. Her family believed, as part of their culture
system and society, that people with epilepsy, because of
their seizures, had an innate power to become healers. The
Hmong shamans were chosen by healing spirits that would
induce the seizures, a pre-requisite for entering in a tran-
ce and being able to heal other people by acting in a sort
of spiritual plane. This particular girl was administered
different medications in varying combinations over several
months, until going into status and ending up in a
vegetative state. Cultural barriers played a large role in
the outcome, as several times no translator was available
to help either the physicians or the family to interact and
also because the family regarded the physicians with
distrust.
Even in some parts of Europe religion is still inter-
mingled with epilepsy. In 1999 a study of the prevalence
of epilepsy in rural Hungary(9) showed that of the
415 interviewed patients, 65% had consulted with reli-
gious figures at some point during the course of their
disease.
Despite current information resources leading to
widespread access to knowledge in urban areas, not
previously available for lay people, epilepsy still carries
several social stigmas, even among people who do not
perceive it as some sort of preternatural phenomenon.
Epileptic patients, regardless of the country they live in,
have fewer opportunities for marriage, employment and
education(10).
231
Another Hungarian study recently published(11)
employed a questionnaire to survey in two different times
(1994 and 2000) public perceptions regarding epilepsy.
Epileptic patients or their relatives were excluded; in both
surveys 1,000 people were addressed. Even though the
percentage of people who could identify correct causes of
epilepsy (e.g.: birth trauma, brain injury, disease of the
nerves, heredity) remained stable (from 45,7% to 48,7%),
a large proportion of respondents (45,4%) did not know
any cause of epilepsy and it was considered a form of
insanity by 17,2% of the interviewed people. Conversely,
attitudes towards people with epilepsy had a positive
change, as there was a significant reduction from 1994 to
2000 of the proportion of people who objected to their
children being in contact with epileptic patients or who
perceived negatively marrying someone with epilepsy. Also,
more people favored equal employment.
In Brazil a recent study by Arida et al.(12) evaluated
exercise habits in epileptic patients. Among the barriers
to engaging in physical activities, the most common
epilepsy-specific cause was fear of being embarrassed by
having a seizure while exercising. Surprisingly, a great
number of patients (15%) were advised by a physician to
avoid most types of exercise, a figure similar to the
proportion of patients who were discouraged from
exercising by a family member or friend (14%). In addition,
other non-specific related causes for not exercising
included excuses commonly used by healthy subjects, such
as not having time to exercise (25%), getting tired after
exercise (38%) and those who did not like to exercise
(18%).
Psychiatric co-morbidities, however, apparently do
not vary that much in different populations, with similar
severe social issues in both developed and developing
countries(13). To that effect, a joint review study by
Matsuura and Trimble(14), of Japanese epileptic patients
showed that the clinical presentations of psychoses were the
same as those reported in European observational studies.
Finally, non-epileptic seizures, a rather frequent cau-
se of intractable seizures (20%) in tertiary epilepsy centers,
do not seem to differ in their clinical presentation in
different cultures, as reported in a recent Indian study(15).
In brief, in spite of all the cultural and information
advances, some misconceptions about epilepsy still remain
in modern times, mostly related to a belief that epilepsy
can be the result of supernatural causes. Other aspects,
such as prejudice or co-morbidities, do not seem to differ
greatly between Eastern or Western cultures. There’s still
a bulk of regional issues, like predominant etiologies, access
to medication, social issues, access to comprehensive
centers, to name a few, that are too broad to evaluate in
conjunction and are beyond the scope of this review.
 Germiniani F, Crippa A, Pereira E, et al.
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Address correspondence to:
Francisco M. B. Germiniani,
Serviço de Neurologia – Hospital de Clínicas da Universidade Federal do Paraná
Rua General Carneiro, 181 – 12º andar
CEP 80060-900, Curitiba, PR, Brazil