William James West (1794-1848): abdominal surgeon and distraught father

Disease versus disease: Paolo Zacchia on syphilis and epilepsy

The lawyer and physician Paolo Zacchia (1584-1659) was the chief physician at the Vatican and an important advisor to the papal court. He is considered a founder of the field of forensic pathology, and the influence of his masterwork, Quaestiones medico-legales, spread throughout Europe. In this essay, we focus on one of Zacchia's consultations, first published posthumously in 1661. Emerging from a cause for beatification, the case features the intriguing medical notion of one disease curing another. Zacchia was to determine if a young man's recovery from epilepsy was miraculous or not. We will briefly review Zacchia's career, examine his argument and the sources on which he based his reasoning in this case, trace the status of the disease-versus-disease notion to the present, and demonstrate that this consultation represents a rare, if not the only example of syphilis being the curative agent - rather than the disease cured.

The contribution of British general practice to our knowledge of epilepsy and its effects on people

INTRODUCTION

British general practice is a good base for epidemiological research which is evidenced by the study of epilepsy.

SOURCES OF DATA

A comprehensive search of PubMed using various keywords for articles on epilepsy research performed in British general practice.

AREAS OF AGREEMENT

Studies in the setting of general practice have contributed significantly to knowledge in the field of epilepsy, especially in relation to epidemiology, studies of prognosis and treatment patterns and psychosocial aspects.

AREAS OF CONTROVERSY

The extent to which epilepsy can be managed in general practice.

GROWING POINTS

The importance of primary care research and the importance of collaborative studies between general practice, hospital and university departments.

AREAS TIMELY FOR DEVELOPING RESEARCH

The effects of interventions at general practice level on seizure control, morbidity and mortality.

A dialogue with historical concepts of epilepsy from the Babylonians to Hughlings Jackson: persistent beliefs

Epilepsy is one of the few neurological disorders to be recognized in Antiquity. The etiology of epilepsy has evolved from affliction of evil spirits and bad omens to an organic disease of the brain. Geographically separate cultures have recognized the diverse symptomatology of epilepsy from vigorous convulsions to spontaneous localized jerking since times immemorial. Similarly, the diagnostic procedures and treatment options have varied in different milieus. In this review we have followed the course of history chronologically from Babylonians to Hughlings Jackson, mapping the conceptual development of epilepsy and the origin of some of the positive and negative attitudes inherited into today's epileptology. Original writings, such as Hughlings Jackson's letters, and English translations of early Latin work, where available, were used as primary sources of information. Where primary sources were not accessible, we consulted research articles, books, and commentaries by eminent historians and epileptologists.

Can we improve the outcome of epileptic encephalopathies?

The Canadian pediatric epilepsy network defines an epileptic encephalopathy (EE) as: “a brain dysfunction manifested by a progressive decline in cognitive and behavioral functions that is associated with frequent seizures and/or interictal epileptiform discharges in a child with medically refractory epilepsy.” Outcomes of these EEs are usually poor owing to the presence of continuous epileptic discharges and/or very frequent seizures, leading to excitotoxic cell death. In addition, early diagnosis is often delayed because of the subtle initial manifestations, and an inadequate choice of treatment not only worsens the seizures acutely but possibly alters long-term prognosis. Steroids, a ketogenic diet and vagal nerve stimulation are possible alternatives to improve the outcome of certain EEs, but I believe developing new therapeutic agents that target the mechanisms implicated in animal models should be favored. Possible targets include γ-aminobutyric acid B receptors, calcium channels or intracellular calcium stores.