Epilepsy historical perspective
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Vishnu Vardhan Serla M.B.B.S. [2]
Historical Perspective
The word epilepsy is derived from the Greek epilepsia, which in turn can be broken in to epi- (upon) and lepsis (to take hold of, or seizure)[1] In the past, epilepsy was associated with religious experiences and even demonic possession. In ancient times, epilepsy was known as the "Sacred Disease" because people thought that epileptic seizures were a form of attack by demons, or that the visions experienced by persons with epilepsy were sent by the gods. Among animist Hmong families, for example, epilepsy was understood as an attack by an evil spirit, but the affected person could become revered as a shaman through these otherworldly experiences.[3]
However, in most cultures, persons with epilepsy have been stigmatized, shunned, or even imprisoned; in the Salpêtrière, the birthplace of modern neurology, Jean-Martin Charcot found people with epilepsy side-by-side with the mentally retarded, those with chronic syphilis, and the criminally insane. In Tanzania to this day, as with other parts of Africa, epilepsy is associated with possession by evil spirits, witchcraft, or poisoning and is believed by many to be contagious.[2] In ancient Rome, epilepsy was known as the Morbus Comitialis ('disease of the assembly hall') and was seen as a curse from the gods.
Stigma continues to this day, in both the public and private spheres, but polls suggest it is generally decreasing with time, at least in the developed world; Hippocrates remarked that epilepsy would cease to be considered divine the day it was understood.[3]
Legal Implications
Most people diagnosed with epilepsy are forbidden by their local laws from operating vehicles. However, there are usually exceptions for those who can prove that they have stabilized their condition. Those few whose seizures do not cause impairment of consciousness, or whose seizures only arise from sleep, may be exempt from such restrictions, depending on local laws. There is an ongoing debate in bioethics over who should bear the burden of ensuring that an epilepsy patient does not drive a car or fly an airplane.
In the U.S., people with epilepsy can drive if their seizures are controlled with treatment and they meet the licensing requirements in their state. How long they have to be free of seizures varies in different states, but it is most likely to be between three months and a year.[4][5] The majority of the 50 states place the burden on patients to report their condition to appropriate licensing authorities so that their privileges can be revoked where appropriate. A minority of states (including California) place the burden of reporting on the patient's physician. After reporting is carried out, it is usually the driver's licensing agency that decides to revoke or restrict a driver's license.
In the UK, it is the responsibility of the patients to inform the Driver and Vehicle Licensing Agency (DVLA) if they have epilepsy.[6] The DVLA rules are quite complex,[7] but in summary,[8] those continuing to have seizures or who are within 6 months of medication change may have their licence revoked. A doctor who becomes aware that a patient with uncontrolled epilepsy is continuing to drive has, after reminding the patient of their responsibility, a duty to break confidentiality and inform the DVLA. The doctor should advise the patient of the disclosure and the reasons why their failure to notify the agency obliged the doctor to act.
Important Investigators of Epilepsy
- Jean-Martin Charcot
- John Hughlings Jackson
- Hans Berger
- Herbert Jasper
- Wilder Penfield
- H. Houston Merritt
- William G. Lennox
References
- ↑ Harper, Douglas (2001). "epilepsy". Online Etymological Dictionary. Retrieved 2005-06-05.
- ↑ Morbus sacer in Africa: some religious aspects of epilepsy in traditional cultures. Jilek-Aall L. PMID: 10080524 Retrieved 8 October 2006.
- ↑ Hippocrates quotes
- ↑ Epilepsy Foundation Driving and You - Can you drive an automobile if you have epilepsy?.
- ↑ Epilepsy Foundation Driver Information by State
- ↑ UK Epilepsy Action: Driving and Epilepsy, I've had a seizure. What should I do?
- ↑ UK Driver and Vehicle Licensing Agency Guide to the Current Medical Standards Of Fitness to Drive. Full details for doctors regarding epilepsy are given in the Appendix. Information for drivers can be found in Medical Rules - Group 1 Licence Holders
- ↑ UK Epilepsy Action: booklet with further details about driving PDF