Despite the significant clinical and therapeutic progress for centuries, people with epilepsy continue to suffer from discrimination due to the idea of epilepsy is caused by spirits or divine experiences.
Epilepsy is one of the most common serious brain disorders but is often surrounded by prejudice and myth, which can be overcome only with enormous difficulties. Epilepsy was frequently documented in ancient times. Throughout the ages, in different parts of the world and in different cultures, epilepsy has been associated with many misconceptions. However, its sudden and dramatic seizures, have been so mystifying. People with epilepsy were regarded as “being chosen” or “being possessed,” depending on the prevailing popular belief; this affected treatment and society’s attitudes towards people with epilepsy.
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The belief that epilepsy is contagious, dates to antiquity when people used to spit at a person with the condition and refused to use the same dish. In the early Christian churches, clergy and synods segregated people with the problem of epilepsy from the faithful, because they were afraid that the people with the disease would desecrate the holy objects and would infect the communion plate and cup. Such beliefs are also common during the late Middle Ages.
Due to the idea of epilepsy is caused by spiritual or divine experiences, people with the problem of epilepsy were facing many challenges from family, friends, and society. Due to the belief, people couldn’t get a job, attend social events and live their life as other fellow human beings did. This brought psychological, social, and economical problems to the people. The psychological, social, and economical problems were creating more problems and complicate the situation.
Epilepsy is a chronic neurological disorder in which the nerve cells, or neurons, in the brain fire signals abnormally and cause a recurrent seizure, of which there are many varieties. These seizures have many causes and treatment options. In some cases, they can even be completely controlled, epilepsy was not always known to be a medical issue also thought to be caused by spirits or divine experiences.
The advancement in technology over the years open the gate to know more about epilepsy and seizures, like how and why they occur in some cases and the advancement helps to identify symptoms and signs on specific areas of the brain activated by the abnormal electrical activity and classify. If the abnormal activation is on the entire brain or a large part of the brain involved and loss of awareness without any warning is called generalized epilepsy. If the seizure starts from a small area of the brain and may experience a warning, known as an aura, named focal epilepsy.
The history of epilepsy is intermingled with the history of human existence; the first reports on epilepsy can be traced back to the Assyrian texts, almost 2,000 B.C. Many references to epilepsy can be found in the ancient texts of all civilizations, mostly in the ancient Greek medical text like the Hippocratic collection of medical writing. However, it was not until the 18th and 19th centuries, when medicine made important advances and research on epilepsy was emancipated from religious superstitions such as the fact that epilepsy was a divine punishment or possession.
The study by physiologist Fritsch and psychiatrist Hitzig “On the Electric Excitability of the Cerebrum”. The experiment was done by provoking seizures by electric stimulation in the brain cortex of dogs. The study helps to identify the pathophysiology of epilepsy and the topographic localization of epileptic seizures and epileptic mechanisms, which shows epilepsy derives from the brain. On the other side advancement in the field of the microscopic structure of the brain and the nervous system, helps to describe the structure of neurons and synapses. Another study during the 1940s, important discoveries were made in the field of psychomotor epilepsy, showed that changes in the behavior of monkeys could be associated with temporal lobe lesions research identifying various neural pathways within the brain and pointing out the important role in alert wakefulness as a background for sensory perception, higher intellectual activity, voluntary movements, and behaviors.
EEG and the electrophysiology of epilepsy which shows the association of electric stimuli and brain activity and examined the electrical activity of nerve-muscle preparations before epilepsy happens and explored the possibility of whether similar changes in electrical potential occurred in the brain during the normal functioning time of the brain. A study on the electrophysiology of epilepsy shows electric changes in the brain during experimentally induced seizures, associating epileptic attacks with abnormal electric discharges.
Surgical procedures were one of the treatment options performed during the 19th century on epileptic patients. Heyman in 1831 was the first one to perform surgery on an epileptic patient due to a brain abscess. At the beginning of the 20th century, a procedure called hemispherectomy was introduced as a neurosurgical procedure. However, important advancements were not made in epileptic surgery until the 1930s. One of the advancements in the development of surgical techniques in epileptic surgery was the introduction of EEG.
One of the surgical procedures that contributed to the evolution of the surgery of epilepsy was a surgery done by Penfield along with Jasper and Theodore Brown Rasmussen in the Neurologic Center of the University of Montreal. The procedure was removing epileptogenic lesions on an epilepsy patient. According to the Montreal procedure, through the administration of local anesthetic on specific areas of the brain, the surgeon removes the skull and the conscious patient describes to the surgeon his/her feelings so that the surgeon can identify the exact location of seizure activity. Then the surgeon proceeds the procedure in the removal of brain tissue in a specific location reducing the side effects of surgery. Through his operations, the surgeon was able to identify various brain centers and to create maps of the sensory and motor cortices of the brain. Another technique was the use of parallel X-ray beams that would avoid distortions of the skull, vessels, ventricles, and the frame and grids used for guiding the placement of intracranial electrodes.
At the beginning of the 1980s, the advent of modern diagnostic techniques such as MRI, PET, and SPECT (single photon emission tomography), 31P and 1H-MR spectroscopy, and MEG (magnetoencephalography) revolutionized epileptic. The advancement leads to the application of microsurgery led to selective operations with fewer complications.
Early 19th-century epilepsy was considered incurable and mostly the management was preventive and only one drug was used which is called bromine. Accidents, injuries, lead poison, and other kinds of poisoning in the parents of children, arteriosclerosis, and high blood pressure are thought to be the cause of epilepsy. Education of an epileptic child and parents will minimize the impact and easier for treatment and better improvement. The prevention methods were rubber between teeth, not giving treatment during the seizure. Epilepsy does not prevent us from doing whatever we want Julius Cassar, Napoleon, Alexander, Mohamed, and peter the great was some of the notable people in the world with the problem of epilepsy.
Treatment of epilepsy until the 1850s mostly consisted of herbal and chemical substances. In 1857, Sir Locock discovered the anticonvulsant and sedative traits of potassium bromide was a huge discovery to treat epilepsy. Starting from that, potassium bromide became a choice treatment for humans with epileptic seizures and nervous disorders until the 1912 discovery of phenobarbital by German physician Hauptmann. The introduction of animal models in the study of the properties of the anticonvulsant drug contribute to the development of new antiepileptic drugs, this leads to the discovery of a new drug called phenytoin in 1938. The drug Phenytoin became the first-line medication for the prevention of partial and tonic-clonic seizures and for acute cases of epilepsies or status epilepticus, giving an alternative therapeutic choice for patients not responding to bromides or barbiturates. In 1946, a new antiepileptic drug was added in the quiver of antiepileptic therapy, trimethadione; it was reported by Richards and Everett to prevent pentylenetetrazol-induced seizures and to be effective especially in the absence of seizures.
The last decades many new antiepileptic drugs such as vigabatrin, lamotrigine, oxcarbazepine, gabapentin, felbamate, topiramate, tiagabine, zonisamide, levetiracetam, stiripentol, pregabalin, rufinamide, lacosamide, eslicarbazepine, and perampanel were used. Carbamazepine was the first drug to be licensed by the FDA and ended clinical use of some of the drugs like felbamate due to its associated complications. Research in antiepileptic drugs is a very active field of study and many drugs are currently under development in clinical trials including eslicarbazepine acetate, brivaracetam, and retigabine.
One of the important advancements in epilepsy treatment was the development of vagus nerve stimulation (VNS) techniques, this technique is very important especially for patients experiencing serious adverse effects of antiepileptic drugs. VNS involves the implantation of a programmable signal generator (neurocybernetic prosthesis NCP) in the chest cavity, and the stimulating electrodes carry electrical signals from the generator to the left vagus nerve.
Alternative or complementary therapies have emerged in the therapy of epilepsy including relaxation therapies such as massage, aromatherapy, reflexology, and chiropractic therapy, holistic therapies such as herbal medicine, homeopathy, Ayurvedic medicine, and traditional Chinese medicine (herbal remedies plus acupuncture), traditional and psychological therapies such as autogenic training, neurofeedback, and other psychological therapies, and music therapy. Recent studies have pinpointed the use of cannabidiol and medical marijuana for the treatment of epilepsy.
The first connection between heredity and epilepsy was made in 1903 by Lundborg, a Swedish physician, his analysis was pioneering. He was able to trace back the disease in the family since the 18th century. However, the most important evolution in the field of the genetics of epilepsy took place during the last twenty years; in 1989, Leppert was the first to identify the link between chromosome 20 and idiopathic human epilepsy syndrome in a family with benign familial neonatal convulsions. The growing evidence on the connection between various genes and epilepsies is the cutting edge of modern epilepsy research, and in the next decades, new exciting discoveries are going to change epileptology. The identification of reliable biomarkers would greatly facilitate differential diagnosis, eliminate the trial-and-error approach to pharmacotherapy, facilitate presurgical evaluation, and greatly improve the cost-effectiveness of drug discovery and clinical trials of agents designed to treat, prevent, and cure epilepsy.
This historical journey offered thoughts from professionals and unprofessional people regarding epilepsy in ancient and present times. It's somewhat unsatisfactory that, despite the significant clinical and therapeutic progress for centuries and the action of some progress, misconceptions stay and people with epilepsy still suffer from prejudice and discrimination. The media usually compounds these issues by spreading inaccurate information. There square measure only a few alternative sicknesses that suffer therefore greatly from such untruth. However, the lives of illustrious individuals with epilepsy might function as an example to others, to the media, and to anybody prejudiced against individuals with the condition. Yet, to boost the standard of life of individuals with epilepsy worldwide, significant efforts are required to teach the media and the general public, likewise the professionals and the individuals with epilepsy themselves.
The fascinating history of epilepsy relates to the history of humanity; early reports on epilepsy return to the traditional Assyrian texts, scanning amounts of just about 4000 years. the primary hallmark within the history of unwellness is that the medical practitioner texts that set unsure the divine origin of the disease. Major advances within the understanding of epilepsy came to a lot of later, throughout the eighteenth and nineteenth century; theories on epilepsy throughout this era square measure developed on a solid scientific basis and epileptics square measure for the first time treated as patients and not as possessed. Throughout this era, experimental studies were conducted, and advances were created within the pathology of the disease and the affiliation of epilepsy with varied psychiatrical symptoms. The arrival of the twentieth-century crystal rectifier to the in-depth understanding of the mechanisms of the disease, the event of effective medication, and neuroimaging strategies. Finally, one should mention the important advances in the molecular biology of the disease and the connection of various genes with various forms of epilepsy.
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