Friday, February 02, 2007

Trephination: a girl's best friend?

TGIF: another history of medicine class, and another reason to be thankful for modern medical care.

lecture to the second-year medical students was delivered by Dr. James Cereghino of the OHSU Dept. of Neurology. His talk, on the history of epilepsy, outlined how far humankind has come since, well, the dawn of civilization--which is how long epilepsy has been with us. However, no one wrote about the disease until 400 B.C.; that's when Hippocrates wrote his treatise, On the sacred disease, which actually debunked the prevailing theory that epilepsy was a divine gift.

From divine disease, epilepsy was downgraded to demonic possession by the Romans and others after them. When patients were treated, they were given, according to Cereghino, pretty much "anything that could be swallowed" (and not nice things like champagne, either). Other options included witchcraft and castration or hysterectomy (since most patients were women, epilepsy became associated with general hysteria). With those as alternatives, some patients were probably glad to hear that their doctor had opted for the more scientific treatment by trephination.

These modes remained in wide use until the 19th century, when bromide came to the fore. Alas, everything has its downside: bromide caused boils. Phenobarbitol, introduced in 1912, has been found to lower IQs. And the side effects of thalidomide ultimately resulted in changes to the way medicines are developed and tested.

Cereghino noted that he's not sure how long the term "epilepsy" will continue to be used. Like "fever," epilepsy is an umbrella term for a number of subcategories of syndromes. Once the data has been gathered and analyzed, will it still be classified as a disease? Or, like fever, will it be recognized as a symptom of a larger problem? Only time will tell.

In the meantime, if you'd like a comprehensive look at the history of epilepsy, check out Owsei Temkin's book The Falling Sickness, which remains the standard in the field 60 years after its initial publication.

And final note for you romantics out there: Saint Valentine is the patron saint of epileptics. Slip that into your loved one's card this year!

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