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Tuesday, March 22, 2022

Epilepsy: The Sacred Disease

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Many advances in treatment for ancient ailment

What do Julius Caesar, Joan of Arc, Vincent van Gogh and the actor Danny Glover have in common? All these famous people from different epochs were thought to have epilepsy.

Epilepsy is an ancient disease that has been a source of curiosity and fascination. In fact, there are biblical references to epilepsy. In Matthew 17:15: “And when they came to the crowd, a man came up to him and, kneeling before him, said, “Lord, have mercy on my son, for he is an epileptic, and he suffers terribly. For often he falls into the fire, and often into the water.”

One of the earliest historical references to epilepsy is a 2,700-year-old cuneiform tablet depicting the image of a demon with horns, tails and a snake’s tongue with an accompanying text claiming that this “demon” was the cause of a dreaded ailment called Bennu-epilepsy. In 1951, a Babylonian text dating back to the middle of the first millennium BC was excavated. This artifact described different seizure types attributable to ghosts or demons. Clearly, during antiquity, it is widely believed that supernatural entities caused epilepsy. The early Greeks thought of epilepsy as the “Sacred Disease” as the fits and faints often seen in patients with epilepsy were considered to be of “divine” origin.

Over time, advances in anatomy, pathology and the allied sciences of physiology and pharmacology increased our understanding of epilepsy as a biological disorder with causes rooted in alterations in normal brain functioning.

According to the CDC, “In 2015, 1.2% of the US population had active epilepsy. This is about 3.4 million people with epilepsy nationwide: three million adults and 470,000 children.” In Louisiana, it is estimated that 54,900 people have epilepsy, 7,900 of which are children 17 years old and below. Epilepsy is now defined as a disorder characterized by two or more unprovoked seizures occurring more than 24 hours apart. Or one or more unprovoked seizures and probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years. Hence, recurrent seizures often lead to a diagnosis of epilepsy.

In the last 100 years, we have made even more significant strides in understanding and treating epilepsy. With the discovery of the antiseizure drug Phenytoin in 1938 and the explosive discovery of many newer antiseizure medications from the 1990s (“the Decade of the Brain”) to the present, we now have over 30 antiseizure drugs available for treating epilepsy. Cannabidiol, a non-psychoactive tetrahydro cannabidiol derivative, has also been recently approved for specific types of epilepsy.

Moreover, with new surgical techniques, many epilepsies can now be treated and even cured. These include implantable devices such as the Vagus nerve stimulator (approved in 1999), Responsive Nerve Stimulator (approved in 2014) and the Deep Brain Stimulator (approved in 2018). A new laser therapy called LITT, or laser interstitial therapy, allows for less invasive brain surgery and shorter postoperative recovery and can be highly successful in some patients.

However, despite all these advances, epilepsy remains a substantial public health problem, with people continuing to have untreated or inadequately treated seizures due to a wide disparity in access to care and resources among different socio-economic groups. Sadly, much more work will need to be done from all sectors. We hope that the future will bring more technological innovations to treat epilepsy and reforms and public health policies that will minimize, if not abolish, health disparities in people with epilepsy.

Rosario Riel-Romero, MD, FAAP, FAAN, FACNS, is the clinical professor of neurology and pediatrics at LSU Health Shreveport.

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