Rewriting History: Did All Those Famous People Really Have Epilepsy?

Napoleon Bonaparte once said, “History is the version of past events that people have decided to agree upon.” But what if the “version of past events are disputed?” Where does that leave history and more importantly who determines the accuracy of these events? Dr. John Hughes, Department of Neurology, School of Medicine, University of Illinois at Chicago decided to dive headlong into this question while researching the extensive timeline of historical figures reported to have suffered with epilepsy. “History is only as accurate as how carefully we’ve looked at these events. If we don’t carefully examine events reported to be epileptic seizures, then we are misled into the diagnosis of epilepsy”, said Hughes. Hughes investigated 43 historical figures reported to have had epilepsy ranging chronologically from Pythagorus, born in 582 BC, to the actor Richard Burton, born in 1925. According to Hughes, “All of these people had been reported to have had various kinds of attacks, but they did not have epilepsy.”

Research Methods

Hughes gathered data on each historical figure using the Internet as well as books obtained from both public and university libraries. The references include recent books published after 1990 (29%), 1980 (42%), and 1970 (58%). Only 23% of the references are older than 1950. In total, Hughes consulted 154 sources.

Results

Surprisingly, Hughes found that all 43 famous people did not have epilepsy, but various other health related illnesses including psychogenic attacks, anxiety attacks, and alcohol withdrawal seizures. Of the 43 historic figures, “epilepsy was misdiagnosed in 26 % who had psychogenic attacks, in 21 % with attacks of anguish, nervousness, fear, agitation, or weakness; and in 12% with alcohol withdrawal seizures.” He maintains that the descriptions offered either by the biographer or by the individual who had the attack often contained the word “fit” --“fit of pain”, “anxiety fit”, “fit of spleen” . Based on this evidence he asserts that improper conclusions were then drawn to diagnose epilepsy. He also argues that “all epileptic attacks should involve some change in awareness on the part of the patient, with the exception of simple partial seizures. In the research he collected there were many instances in which the individual admitted awareness, while many different movements or symptoms were present.” Furthermore, the length of the attack was an important clue that the attack was psychogenic and not epileptic; most psychogenic attacks are longer than 5 minutes while most complex partial or generalized tonic-clonic seizures only last 1-2 minutes.

In addition, 40% of the 43 famous people investigated in this study, had severe health problems as an infant or small child.

What Are Psychogenic Seizures?

Events that look like seizures, but are not due to epilepsy are called "nonepileptic seizures." A common type is described as psychogenic, which means beginning in the mind. Psychogenic seizures are caused by subconscious mental activity, not abnormal electrical activity in the brain. Doctors consider most of them psychological in nature, but not purposely produced. Usually the person is not aware that the spells are not "epileptic." The term "pseudoseizures" has also been used (mostly in the past) to refer to these events.

How Common Are Psychogenic Seizures?

Psychogenic nonepileptic seizures are common. About 20% of the patients referred to comprehensive epilepsy centers for study with video-EEG are found to have nonepileptic seizures. About 1 in 6 of these patients either also has epileptic seizures or has had them, however. These people need different treatment for each disorder. Psychogenic nonepileptic seizures have been more widely recognized during the past several decades. They are most often seen in adolescents and young adults, but they also can occur in children and the elderly. They are three times more common in females.

What Does A Psychogenic Seizure Look Like?

The seizures most often imitate complex partial or tonic-clonic (grand mal) seizures. Family members report episodes in which the patient stiffens and jerks. Doctors rarely witness the actual event, so they are drawn toward the diagnosis of epilepsy. Often years can be spent trying to treat the spells as epileptic seizures without success. Doctors have identified certain kinds of movements and other patterns that seem to be more common in psychogenic nonepileptic seizures, than in seizures caused by epilepsy. Some of these patterns do occur occasionally in epileptic seizures, however, having one of them does not necessarily mean that the seizure was nonepileptic.

How Are Psychogenic Seizures Diagnosed?

Video-EEG monitoring is the most effective way of diagnosing nonepileptic seizures. The doctor may take steps to provoke a seizure and then ask a family member or friend of the patient to confirm that the event was the same as the usual kind. Psychogenic nonepileptic seizures do not necessarily indicate that the person has a serious psychiatric disorder. The problem does need to be addressed and many patients need treatment. Sometimes the episodes stop when the person learns that they are psychological. Some people have depression or anxiety disorders that can be helped by medication. Counseling for a limited time is often helpful.

Alcohol Withdrawal Seizures

When alcohol is related to seizures, it has been found that it is nearly always the state of alcohol withdrawal that aggravates seizures, rather than drinking itself. Your risk of seizures may be much higher after consuming three or more alcoholic beverages. These alcohol withdrawal seizures may begin between 6 and 72 hours after you stop drinking. Studies suggest that alcohol withdrawal seizures most often occur 7 or 8 hours after heavy or prolonged drinking has stopped. Alcoholism, or chronic abuse of alcohol, has been shown in recent studies to be associated with the development of epilepsy in some people. These experiments suggest that repeated alcohol withdrawal seizures may make the brain more excitable. Thus, people who have experienced seizures provoked by binge drinking may begin to experience unprovoked epileptic seizures ("alcoholic epilepsy") regardless of alcohol consumption.

Implications of the Results

When asked why he wanted to study this particular subject Hughes replied, “I wanted to investigate the accuracy of a diagnosis of epilepsy in these historical figures because first off. Let’s get history right. I don’t want to see people quoting history incorrectly. The other thing is, all the reasons why these 43 people were thought to have epilepsy is why patients are referred to epileptologists today.” Hughes believes the misdiagnosis of epilepsy is both a problem of the past as well as the present, “Although conditions today are very different compared with the many eras sampled in this review, the reported 20-30% of epileptologists who do not correctly differentiate psychogenic from epileptic disorders is similar to our 26% today. The 12% of incorrect diagnoses from alcohol withdrawal attacks in this report is similar to the 10% of the adult population who, in the 1950’s admitted consuming large amounts of alcohol.”

Commentary

If history is in fact a “version of events that people have decided to agree upon”, then it is quite possible the timeline of famous people with epilepsy is questionable. Although, it is also important to remember that the means with which these historical figures were diagnosed pales in comparison to the technology we have today. Hence, perhaps the definition of epilepsy, like technology, is an ever evolving process which changes as we gain scientific knowledge about the complexities of epilepsy and the brain. Perhaps by today’s standards, yesterday’s diagnoses are inaccurate-perhaps. Hughes’ findings encourage us to rethink what has generally come to be thought of as history. However, his research does not negate the fact that famous people with epilepsy are capable of great accomplishments worthy of fame. In conclusion, we look forward to further work that establishes a definite diagnosis of epilepsy amongst historical figures.

To obtain a copy of Dr. John Hughes’ research you may go to: www.sciencedirect.com