Hippocrates, Galen, and the patient with epilepsy. Some new perspectives on the old masters.

This article reads the old masters with the eyes of a clinical epileptologist. "On the Sacred Disease" is a flaming pamphlet against beliefs in supernatural causes of epilepsy. Hippocrates' statement that it has natural causes like all other diseases builds primarily on heredity and seat in the brain. Heredity is mainly based on predisposition to epilepsy by an inherited constitution. The cerebral origin follows earlier traditions, supported by the observation of acute traumatic seizures. Infantile hemiplegia following seizures may refer to the H.H.E. syndrome. Bilateral and unilateral tonic-clonic seizures, startle seizures and breath-holding spells are described as well as sleep-related paroxysms (night terror, sleep behaviour disorder, frontal lobe seizures and sleep apnea). Patients' reactions to warnings reveal stigma. Seizures are not random events but result from antagonistic influences in body and environment. The physician's task is to understand these and provide the patient with a comprehensive regimen to keep them in balance. For Galen, epilepsy was not one disease but included multiple conditions. His standard regimen consisted essentially in a highly disciplined lifestyle, with drugs in a merely supportive function. His novel interest in patients' seizure experiences established the term "aura" and the subjective history of epilepsy. The first account of an aura documents its typical indescribability. Hippocrates and Galen are distinguished from the non-scientific approaches of their time first of all ethically, i.e. by their respect for their patients' dignity and autonomy.