1. The Ancient Greeks thought of epilepsy as a sacred disease, and there has always been an aura of mysticism and superstition that surrounds it. Many great people through history are said to have suffered from epilepsy, and the cases of men such as Hercules and Aristotle inspired Hippocrates to call it the "great disease" (or grande mal). However, many of the famous and oft-cited cases may not fit our current definition. Would you diagnose the following people with epilepsy?
a. Alexander the Great - Collapsed once after taking an herbal medicine for a lung problem brought on by swimming in a cold river.
b. Edgar Allen Poe - Suffered from complex partial seizures in his later life, said to have been brought on by his bouts of alcoholism.
c. Napoleon - Had seizures resulting from kidney failure and exacerbated by stress.
d. Van Gogh - Most frequently cited "epileptic". Most of his documented seizures are linked to consumption of potent absinthe liquor, which in those days contained neurotoxins.
e. Tchaikovsky - Suffered from convulsions at the end of his life while dying of cholera.
f. Julius Caesar - Had four documented episodes that resembled complex partial seizures, and may have suffered further episodes in his youth. Historians argue about his health but in general it was fine until his later years.
Napoleon I on his Imperial Throne by Ingres
2. One famous person who likely suffered from epilepsy was Charles Dickens, and he was lauded by physicians for his accurate portrayal of the disease in his novels. For each character, name the type of seizure described:
a. (Oliver Twist) "The man shook his fists, and gnashed his teeth... He fell violently on the ground: writhing and foaming, in a fit." He was conscious during these events: "These fits come over me... thunder sometimes brings them on."
b. (Bleak House) "Guster falls into a staring and vacant state," appearing as "stunned admiration."
c. (Bleak House) "Guster fell into a fit of unusual duration: which she only came out of to go into another, and another, and so on through a chain of fits, with short intervals between..."
Great Book
3. Another Dickens case: Old Anthony Chuzzlewit had "fallen from his chair in a fit, and lay there battling for each gasp of breath, with every shriveled vein and sinew starting in its place." The next morning "He seemed to utter words, but they were such as man had never heard. And this was the most fearful circumstance of all, to see him standing there, gabbling in an unearthly tongue." What happened? Where? What would you call his deficit?
4. Let us revisit the case of Julius Caesar. Alternative theories have been proposed to explain his history of seizures. In the years leading up to his assassination in 44BC (shown nicely in the painting below), he exhibited increasingly erratic behavior, which included disturbances of consciousness, night terrors, and tremors. He also seemed to disregard his own wellbeing, reacting carelessly to assassination rumors and disbanding his personal bodyguard, which made his contemporaries think he "no longer wished to live". This was all in addition to his seizures and frequent headaches. The great Roman historian Plutarch called Caesar's ailment a "disease of the head," which specific diagnosis could explain all of these findings?
The Death of Caesar by Jean-Leon Gerome
ANSWERS (highlight to see):
1. None except Caesar. Need 2 or more unprovoked seizures.
2. Myoclonic seizures (may or may not lose consciousness, no consciousness in general tonic-clonic )
Absence Seizures
Status Epilepticus
3. Stroke, MCA, Wernicke's aphasia (Broca's would cause non-fluency and omission)
4. Meningioma near the temporal lobe
