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 Epilepsy & Behavior 17 (2010) 103–108

Contents lists available at ScienceDirect

Epilepsy & Behavior

journal homepage: www.elsevier.com/locate/yebeh

Hallmarks in the history of epilepsy: Epilepsy in antiquity

Emmanouil Magiorkinis *, Kalliopi Sidiropoulou, Aristidis Diamantis
Office for the Study of History of Hellenic Naval Medicine, Naval Hospital of Athens, Athens, Greece

a r t i c l e i n f o a b s t r a c t

Article history: The purpose of this article is to highlight the hallmarks of epilepsy as a disease and symptom during
Received 8 September 2009 antiquity and especially during Ancient Greece and Rome. A thorough study of texts, medical books,
Revised 4 October 2009 and reports along with a review of the available literature in PubMed was undertaken. Observations
Accepted 31 October 2009
on epilepsy date back to the medical texts of the Assyrians and Babylonians, almost 2000 years B.C. Con-
Available online 5 December 2009
sidered initially as a divine malady or demonic possession, epilepsy was demythologized by the Father of
Medicine, Hippocrates, who was the first to set in dispute its divine origin. Physicians in the early post-
Keywords:
Hippocratic era did not make any important contribution regarding the mechanisms of epileptic convul-
Epilepsy
Ancient Greece
sions, but contributed mainly in the field of nosology and systemization of symptoms.
Ancient Rome Ó 2009 Elsevier Inc. All rights reserved.
Convulsions
Sacred disease
Seizures

1. The origins of epileptology: First reports
The medical condition of epilepsy is as old as human existence.
The first description of an epileptic seizure appears in a text from
2000 B.C. written in the Akkadian language, used in the region of
Mesopotamia. The author described a patient with symptoms
resembling epilepsy: ‘‘his neck turns left, his hands and feet are
tense and his eyes wide open, and from his mouth froth is flowing
without his having any consciousness.” The exorciser diagnosed
the condition as antasubbû, translated as ‘‘the hand of sin,” brought
about by the god of the Moon [1].
Later reports on epilepsy can also be found in Ancient Egyptian
medical texts. The Edwin Smith surgical papyrus (1700 B.C.) refers
to epileptic convulsions in describing patients who ‘‘shudder
exceedingly” in five separate accounts (cases 4, 7, 29, 40, 42). The
descriptions may be the first reports of focal seizures caused by
cortical irritation resulting from examination or probing of wound
or from an injury (i.e., traumatic epilepsy). In case 4, for example,
epileptic convulsions are described as the result of a gaping wound
of the head:
If thou examinest a man having a gaping wound in his head,
penetrating to the bone, (and) splitting his skull, thou shouldst
palpate his wound. Shouldst thou find something disturbing
therein under thy fingers, (and) he shudders exceedingly, while
the swelling which is over it protrudes.
The passage appears to describe an incident of traumatic epilepsy
caused by a severe injury.
The Babylonians also were aware of epilepsy and described the
condition eloquently while attributing it to evil spirits [2]:
[If at the time] of his fit [the patient] loses consciousness and
foam comes from his mouth, it is miqtu [diurnal epilepsy].
[If at the time] of his fit he loses consciousness and his arms
and legs bend round to the same side as his neck, it is miqtu.
[If] his fit . . . takes hold of him and foam comes from his
mouth, an [unfulfilled] vow made by his father has seized
him. He [the child] will die.
The Sakikku [All Diseases], one of the oldest Babylonian medical
texts (1067–1046 B.C.), refers to epilepsy with the terms antasubba
and miqtu.1 The author refers to various signs for the prognosis,
diagnosis, and treatment of the condition. The Babylonians used
the same term antasubba for all seizures. The translated Babylonian
text describes febrile seizures, seizures in infants, petit and grand
mal seizures, the postictal state, focal and sensory seizures, simple
and complex partial seizures, gelastic seizures, status epilepticus,
and narcolepsy [3,4]. The following passages are indicative of the
descriptions in the Babylonian texts:
If he continually cries out ‘‘Ua ai,” he groans, his spittle flows
from his mouth and his neck is twisted to the right’ and ‘if
the patient continually turns his head to the right, his hands
and his feet are stretched out, his eyes are opened wide toward

* Corresponding author. Address: Leoforos Aianteiou 3-PB 1541, Salamina 18900,

1
Greece. Fax: +30 210 7486382. One can easily note the similarity between the Akkadian word antasubbû and the
E-mail address: mayiork@med.uoa.gr (E. Magiorkinis). Babylonian antasubba.

1525-5050/$ - see front matter Ó 2009 Elsevier Inc. All rights reserved.
doi:10.1016/j.yebeh.2009.10.023
104 E. Magiorkinis et al. / Epilepsy & Behavior 17 (2010) 103–108
the sky, spittle flows his mouth, he makes rumbling noises, he
does not know who he is at the beginning when his [confusional
state] comes over him, AN.TA.SUB.BA [seizure], ‘‘hand” of Sin.—
Epileptic cry with focal seizure
If his limbs tremble [and] twist and his face seems continually
to spin. AN.TA.SUB.BA [seizure]. . . . if his limbs go numb [and]
sting him and his face seems continually to spin, AN.TA.SUB.BA
[seizure].—Simple partial seizure
Affliction of bennu that is observed in the seventh year [after]
birth: he makes senseless noises, [his stomach] is continually
upset, [and] during his falling spell he winds his hands behind
him.—Complex partial seizure
If when [a confusional state] comes over him, his torso [feels]
heavy and stings him [and] afterward it comes over him and he
forgets himself.—Epileptic aura
If a mournful cry continually cries out to him [and] when it
cries out to him he continually answers it, he continually
behaves like an animal caught in a trap [and] when he gets
up, he feels exhausted [and] he gets up but [has to] squat down,
he will come through his illness; a roving rabisu afflicts him.—
Narcolepsy
The Hamurabbi code (1790 B.C.) also refers to epilepsy. The
code states that a slave could be returned and the money refunded
if bennu appeared within the month after the purchase. Bennu,
according to researcher Marten Stol, is another word for epilepsy
[5].
In Indian medicine, medical author Atreya attributed epilepsy
to a brain dysfunction and not to divine intervention. In the Caraka
Samhitā Sutra (6th century B.C.), Atreya defines epilepsy as: ‘‘par-
oxysmal loss of consciousness due to disturbance of memory and
[of] understanding of mind attended with convulsive seizures”
[6]. In the Indian text, four different kinds of epilepsy are descibed,
as are premonitory symptoms and a type of epilepsy called Abas-
mara in which patients lose their memory.
2. Epilepsy in Ancient Greece: The sacred disease
The word epilepsy (epikgwía) originates from the Greek verb
epilambanein (epikalbmeim), which means ‘‘to seize, possess, or
afflict.” Different authors have referred to the condition over the
years by many names: seliniasmos (rekgmiarló1), sacred disease,
Herculian disease (because it affected the semigod Hercules),
demonism. Those names are related either to the etiology of the
condition (e.g., disease of the Moon, sacred disease, demonism)
or to a figure (e.g., Hercules). Furthermore, the belief that the cure
of the disease could be of divine origin may have contributed to its
‘‘sacred” reference. In his work Lithica, Orpheus describes elo-
quently the vengeance of Mene, Goddess of the Moon, on those
with epilepsy [7]:
[T]o prove them sufferers from the sacred ill
For quickly will they bend and forwards tilt,
As to earth it draws them. Smeared by froth
From their own mouths, hither and tither will they turn,
And wallow on the ground. For filled with anger towards them
She laughs to see their woe, Mene, the horrid and swift”
The ancient Greeks considered epilepsy to be a miasma2 (líar-
la) that was cast on the soul. Considered a divine punishment for
sinners, an aura of mysticism and superstition surrounded epilepsy.
The Greeks considered the condition to be connected to Selene
(Rekg mg), the Goddess of the Moon. People who offended her were
afflicted with epilepsy. Callimachus (around 310–240 B.C.), a Greek
2 3
Miasma is a Greek word for ‘‘pollution,” a noxious form of ‘‘bad air.”
poet born in Cyrene of Libya [8], in the post-Hippocratic era, narrates
the story of a girl who was to enter into a marriage that the God
Artemis frowned on. She was thus afflicted by epilepsy:
Toward evening was the maid with pallor seized
From a disease that to wild goats we ban
And wrongly sacred call; A grievous ill
Enfeebling her even to Hades’ brink
A second time the nuptial bed was spread
A second time the maid in sickness lay
For seven months with quartan fever torn.
And yet a third time did they turn their thoughts
Unto the marriage, and the third time too
A deathly chill took hold of Cydippe
Artemide, according to mythology, is Apollo’s sister and the
Goddess of Hunting and Virginity, but she is also a lunar goddess,
vengeful, responsible for sudden death, particularly of young wo-
men after childbirth. According to Hippocrates, it is to Artemide,
a Hippocratic text says, a woman with epilepsy should bring offer-
ings [9]. This dark, lunar side of epilepsy predominates in history
and was extended during Medieval times.
Depending on the special symptoms of the epileptic seizure, the
Greeks would attribute the fits to different deities, such as Cybele,
Poseidon, Mars, Hekate, Hermes, and Apollo. According to Hippo-
cratic texts, for example, if the symptoms included teeth gnashing
or convulsions on the right side, then epilepsy was attributed to
Cybele, whereas if the patient screamed like a horse, then Poseidon
was to blame [10].
According to Plutarch (50–120 A.D.), all babies in Ancient Sparta
were examined by the Lesche (Kervg), a council of the elders of
Sparta. If the baby was in good shape and robust, the council al-
lowed the father to raise it; if not, the child was left alone to die
in the Apothetai (Fpohesai), a chasm in the mountain Taygetus.
Women washed babies not with water, but with undiluted wine,
to test their health. The mothers believed that the undiluted wine
would cause sick babies or babies with epilepsy to have epileptic
convulsions, whereas the healthy babies would became tougher
[11].
Heracletus of Ephesus (535–475 B.C.) made the first reference
to the term sacred disease. However, he did not use it to refer to epi-
leptic seizures: ‘‘He used also to call opinion the sacred disease”
[12]. Alcmaeon of Croton (6th century B.C.) was the first of the
Greek physicians to ascertain that the brain was the organ where
hegemonicon (gcelomijóm)3 is founded, providing the ability for
memory and thoughts to originate. Croton considered the brain to
be the center of the senses, spiritual energy, and the immortal soul
[13]. Democritus of Abdera (5th century B.C.), well known for formu-
lation of the atomic theory, wrote a book on epilepsy (Peqí epikg
wía1), suggesting that the brain is the center of the soul and that
cognition and senses were one and the same, originating from the
same force [14]. In the third book of his The Histories (Thaleia), Her-
odotus of Hallicarnassus (484–425 B.C.), the Father of History, indi-
rectly referred to epilepsy afflicting the Persian King Cambyses II,
whose erratic behavior, according to Herodotus, could be attributed
either to the retribution of an aggrieved god or to the so-called sacred
disease. Herodotus also noted the hereditary nature of the disease
(ej cemeg 1) [15].
The characterization of epilepsy as a ‘‘sacred disease” (ieqg 
móro1, hieri nosos) reflects the ambiguity this disease, affecting
body and mind, inspires, having an Apollonian aspect. Men like
the Persian King Cambyses II, the Roman emperor Caesar, or the
hero Hercules are said to have had epilepsy, and thus, epilepsy
was considered a disease of genius. Aristotle [16] explains why:
Hegemonicon comes from the word hegemon, which means ‘‘sovereign.”
 E. Magiorkinis et al. / Epilepsy & Behavior 17 (2010) 103–108
‘‘epileptics have black bile in excess, as have geniuses who are
prone to become melancholic by black bile.” During the Roman
period, the proceedings of the Senate were interrupted or post-
poned whenever a senator was struck by epilepsy during a session
because epilepsy was considered a bad sign from the gods. For that
reason, the Romans called epilepsy morbus comitialis, because an
epileptic attack tended to spoil the day of the comitia, the assembly
of the people [17].
3. The legacy of Hippocrates: Its divine origin is set in dispute
The first formal description of epilepsy as a disease should be
attributed to the father of medicine, Hippocrates of Kos, in his clas-
sic treatise On the Sacred Disease. In this book, Hippocrates disputes
the divine origin of epilepsy by saying: ‘‘This disease is in my opin-
ion no more divine than any other; it has the same nature as other
diseases, and the cause that gives rise to individual diseases” [18].
He harshly criticized previous doctors who attributed epilepsy to
divine intervention, calling them magicians and charlatans: ‘‘My
own view is that those who first attributed a sacred character to
this malady were like the magicians, purifiers, charlatans and
quacks of our own day, men who claim great piety and superior
knowledge. Being at a loss, and having no treatment which would
help, they concealed and sheltered themselves behind superstition,
and called this illness sacred, in order that their utter ignorance
might not be manifest” [19].
Hippocrates was also the first to attempt a scientific approach
toward the study of epilepsy by suggesting a possible etiology
and therapy for the disease. He was the first to attribute the etiol-
ogy of epilepsy to brain dysfunction: ‘‘The fact is that the cause of
this affection, as of the more serious diseases generally, is the
brain” [20]. He also suggests that heredity plays a role in the mal-
ady: ‘‘Its origin, like that of other diseases, lies in heredity” [18].
The clinical description of the disease is characteristic, including
its unilateral motor signs as well as symptoms of aura: ‘‘[The peo-
ple who] are habituated to their disease have a presentiment when
an attack is imminent, and run away from men, home, if their
house be near, if not, to the most deserted spot, where the fewest
people will see the fall, and immediately hide their heads. This is
the result of shame at their malady, and not, as the many hold,
of fear of the divine” [21].
Hippocrates called epilepsy the ‘‘great disease” [22] and, hence,
originated the term grand mal. He also described symptoms remi-
niscent of focal seizures: ‘‘And I know that many persons in their
sleep groan and cry out, while others seem to be choked and still
others get up and flee outside and are deranged until they wake
up afterwards healthy and sensible as before, only pale and weak,
and this not once but often” [19].
Hippocrates’ view of the origin of epileptic convulsions and
their association with life in utero is also interesting. He states
unequivocally that ‘‘its birth begins in the embryo while it is still
in the womb” [23]. Among the precipitating factors that can lead
to an epileptic seizure are: (1) changes in the winds and tempera-
ture, (2) exposure of the head to the sun, (3) crying, and (4) fear.
The prognosis is also worse when the disease manifests at an
early age: ‘‘Little children when attacked by this disease generally
die, if the flow come on copious and with a south wind; for the
minor veins being thin cannot admit the phlegm because of its
thickness and abundance, but the blood is chilled and congeals,
causing death” [24]. But, for older people, the prognosis is better:
‘‘Older people are not killed by an attack of the disease, nor are
they distorted” [25]. In his other treatise, Injuries of the Head, Hip-
pocrates notes that head injuries often lead to convulsions. He
therefore introduced the idea of post-traumatic epilepsy: ‘‘And,
for the most part, convulsions seize the other side of the body;
105
for, if the wound be situated on the left side, the convulsions will
seize the right side of the body” [26]. Hippocrates appears to have
been aware of focal epileptic seizures: ‘‘Convulsions of the fingers
of the hand, without fever” [27]. Regarding therapy, Hippocrates
considered epilepsy to be curable: ‘‘It is also curable, no less than
other illnesses, unless by long lapse of time it be so ingrained as
to be more powerful than the remedies that are applied” [18].
Famous Greek philosophers also dealt with epilepsy in their
works. Plato (428/427–348/347 B.C.), in his Laws, suggests specific
punishment for people selling slaves with epilepsy:
[I]f a man sells a slave who is suffering, or if a man sells a slave
who is in a consumption, or who has the disease of the stone, or
of strangury, or epilepsy, or some other tedious and incurable
disorder of body or mind, which is not discernible to the ordin-
ary man, if the purchaser be a physician or trainer, he shall have
no right of restitution; nor shall there be any right of restitution
if the seller has told the truth beforehand to the buyer. But if a
skilled person sells to another who is not skilled, let the buyer
appeal for restitution within six months, except in the case of
epilepsy, and then the appeal may be made within a year. The
cause shall be determined by such physicians as the parties
may agree to choose; and the defendant, if he loses the suit,
shall pay double the price at which he sold. If a private person
should sell to another private person, he shall have the right
of restitution, and the decision shall be given as before, but
the defendant, if he be cast, shall only pay back the price of
the slave [28].
Aristotle also dealt with epilepsy. In his Problems, Aristotle sta-
ted that Hercules had a melancholy temperament and that black
bile caused him mental derangement [29], a view also supported
by Hippocrates [30]. He also believes that when manifested early
in youth, epilepsy leads to a mental state resembling the stupor
of extreme drunkeness [31]. In his treatise On Sleep and Waking,
Aristotle compared epilepsy with sleep by stating ‘‘sleep is similar
to epilepsy and in some way, sleep is epilepsy” [32]. He believed
that food produces evaporation into the veins which initially rises
upward and descends again. This process takes place during sleep
and also explains, according to Aristotle, epilepsy [33]. In his Ethica
Nicomachea, Aristotle noted that: ‘‘for wickedness is like a disease
such as dropsy or consumption, while incontinence is like epilepsy;
the former is a permanent, the latter an intermittent badness” [34].
The views and theories of Aristotle on epilepsy affected all physi-
cians in the post-Hippocratic era, as well as in Medieval times, as
the Catholic Church considered his teachings indisputable and be-
yond any criticism. The theory of vapors can be found in the writ-
ings of Galen and other physicians, as well.
4. Epilepsy in the post-Hippocratic era: Alexandrian and Roman
medicine
Lucius Apuleius Platonicus (123/125–180 A.D.), more of a phi-
losopher than a physician, defended himself against the accusation
that he practiced magic on a slave and on a woman by attempting
to prove the scientific interest of his examination, He explained
epilepsy based on the views of Aristotle and Plato, summarizing,
in his Apologia, the contemporary views on epilepsy [35].
Aelius Galenus, or Claudius Galenus (131–201 A.D.), one of the
most famous doctors of the Roman period, systemized nosology
and described epilepsy with accuracy in his classic treatise Medical
Definitions. He defined epilepsy as ‘‘a seizure of the mind and the
senses together with a sudden fall, in some with convulsions, in
others, however, without convulsion. Besides, in these patients
froth flows through the mouth when the evil is abating and past
its height” [36]. He was able to discern three forms of epilepsy:
106 E. Magiorkinis et al. / Epilepsy & Behavior 17 (2010) 103–108
(1) idiopathic, attributed to a primary brain disorder; (2) secondary
forms, attributed to disturbance of cardiac function transmitted
through the flow of liquids secondarily to the brain (epilepsy by
sympathy); and (3) a third type attributed to disturbance of an-
other part of human body that is secondarily transmitted to the
brain. ‘‘In all forms,” Galen wrote, ‘‘it is the brain which is diseased;
either the sickness originates in the brain itself, or it rises in sym-
pathy into the brain from the cardiac orifice of the stomach. Sel-
dom, however, it can have its origin in any part of the body and
then rises to the head in a way which the patient can feel” [37]. Ga-
len also described the aura, a Greek word which originally meant
‘‘breeze,” in his De locis affectis, referring to the symptoms of a case
of a 13-year-old boy: ‘‘I heard the boy say that his condition began
in his lower leg and then moved up through the thigh, the groin
and side of the chest above the affected thigh up to the neck and
then to the head. As soon as [the condition] reached this part, he
said that he was no longer aware of himself. When the doctors
asked what the movement into the head was like, [another] boy
said the movement upwards was like a cold breeze (aura)” [38].
Galen also differentiated epilepsy from tetanus, stating that in epi-
lepsy, the whole body participates with a loss of consciousness
[39]. In general, his views on epilepsy are considered to be verbose,
speculative, and of little practical value [40].
Aretaeus of Cappadocia (1st/2nd century A.D.) was the first to
describe hallucinations that occasionally precede epileptic sei-
zures. He noted that fetid odors, luminous circles of diverse color,
noises from the ears, tremors, and sensations in the hands or feet
may occur before the seizure. He defined epilepsy as ‘‘an illness
of various shapes and horrible,” whereas an isolated epileptic par-
oxysm is an acute affliction [41,42]. He likened a grand mal attack
to the movements of a slaughtered animal and the foam at the
mouth to that of the sea [43]. He also noted the tendency of sei-
zures to recur, once established, and the phenomenon of epileptic
insanity [42]. After the fall to the ground, Aretaeus distinguished
three main periods: manifestation, abatement, cessation. The man-
ifestation is characterized by insensibility and tonic and clonic con-
vulsions. At the end of the abatement stage, patients appear to
suffocate, with concomitant signs including erection of the genital.
During the abatement stage, patients unconsciously discharge ur-
ine, excrement, and semen. Then, a flow of froth ends the suffoca-
tion. At the end of the abatement stage, they arise with the seizure
having ended. During cessation, patients still manifest various
signs of physical and mental discomfort [44]. Aretaeus’ description
of grand mal epilepsy is also exceptional [44]:
In the attack, the person lies insensible, the hands clasped
together by the spasm; the legs not only plaited together, but
also dashed about hither and thither by the tendons. The calam-
ity bears a resemblance to slaughtered bulls; the neck bent, the
head variously distorted, for sometimes it is arched, as it were
forwards, so that the chin rests upon the breast . . . the tongue
protrudes, so as to incur the risk of a great wound, or of a piece
of it being cut off, should the teeth come forcibly together with
the spasm; the eyes rolled inwards, the eyelids for the most part
are separated, and affected with palpitation; but should they
wish to shut the lids, they cannot bring them together, inso-
much that the white of the eyes can be seen from below. The
eyebrows sometimes relax toward the mesial space, as in those
who are frowning, and sometimes retracted to the temples
abnormally, so that the skin about the forehead is greatly
stretched, and the wrinkles in the intersuperciliary space disap-
pear: the cheeks are ruddy and quivering; the lips sometimes
compressed together to a sharp point, and sometimes separated
toward the sides, when they are stretched over the teeth, like as
in persons smiling . . . distension of the vessels in the neck;
inability of speech as in suffocation; insensibility even if you
call loudly. The uttering is a moaning and lamentation; and
the respiration a sense of suffocation . . . the pulse strong, and
quick, and small in the beginning ... but when they come to
the termination of the illness, there are unconscious discharges
of the urine, and watery discharges from the bowels, and in
some cases an evacuation also of the semen . . . the mouth
watery; phlegm copius, thick, cold, and if you should draw it
forth, you might drag out a quantity of it in the form of a
thread. . . . They accordingly spit out foam, as the sea ejects froth
in mighty tempests; and then at length they rise up, the ailment
now being at an end. At the termination, they are torpid in their
members at first, experience heaviness of the head, and loss of
strength, and are languid, pale, spiritless and dejected from the
suffering and shame of the dreadful malady.
His description of the so-called ‘‘epileptic personality” is equally
exceptional. He noted that those with epilepsy tended to be:
[L]anguid, spiritless, stupid, inhuman, and unsociable, at any
period of life; Sleepless, subject to many horrid dreams, without
appetite, and with bad digestion; pale, of a leaden color; slow to
learn, from torpidity of the understanding and of the senses;
dull of hearing; have noises and ringing in the head; utterances
that are indistinct and bewildered, either from the nature of the
disease, or from the wounds during the attacks; the tongue is
rolled about in the mouth convulsively in various ways [45].
He also claimed that epilepsy takes its origin from the head,
either directly or by stimulation of peripheral nerves that have a
sympathetic relation to the head. He also considered the abdomen
as a starting point and adhered mainly to the humoral theory of
Hippocrates to explain the mechanism of the convulsions [46]. Sor-
anus of Ephesus (1st/2nd century A.D.) also referred to epilepsy
without making any contribution to the understanding of the dis-
ease. Soranus and Caelius Aurelianus, who paraphrased Soranus,
give a detailed account of epilepsy symptoms and considered the
meninges as the origin of the malady:
Heaviness and giddiness in the head, an inner noise, which is
felt in the occiput too, tension in the eyes, ringing in the ears
or difficulty in hearing. And together with the vertigo, dimness
of the eyesight or something hanging down before the eyes, as it
were, either similar to the spots of marble that the Greeks call
armarygmata or marmarygas or similar to spider webs or to very
thin clouds or to very small flying animals like gnats. The
patients also perceive tiny sparks, so to speak, or fiery circles
borne around before their eyes. The tongue is not flexible, and
at the same time muscles twitch, and they have pains in the
back between the shoulders. There also follows rigor of the
throat and a concomitant precordial distention of food. Erection
of the genital without evident reason and frequent delight in
sexual intercourse. Sometimes also loss of semen during sleep,
which the Greeks call onirogmon. The mind is anxious and trou-
bled, and they are readily roused to anger for no major reason.
There is forgetfulness for what has been done shortly before-
hand and a ready disposition for things causing gloom [47].
5. Remedies for epilepsy during antiquity
Therapeutic procedures for epilepsy during this period are char-
acterized by uniformity and are based mainly on diet instructions.
The author of the book Sacred Disease suggests one method of treat-
ment: ‘‘For what is conformity gives vigor and increase; what is hos-
tile causes weakness and decay. . . . Whoever knows how to cause in
men by regimen moist or dry, hot or cold, he can cure this disease
also, if he distinguish the seasons for useful treatment, without hav-
ing recourse to purifications and magic’ [48]. In his Epidemics,
 E. Magiorkinis et al. / Epilepsy & Behavior 17 (2010) 103–108 107

Hippocrates recommends complete abstinence from food and drink meninx of these. And when, under the courageous treatment
[49]. In his On Virginity, he recommends marriage and pregnancy in of the physician, the wound has suppurated—or cleaned
order to avoid epileptic seizures during puberty [9]. itself—and turned into a scar, the patient has escaped from
In his book Morbis chronici, Caelius Aurelianus writes that Dio- the disease [59].
cles of Carystus (4th century B.C.) treated patients with epilepsy
according to the underlying cause. Diocles suggested diuretic rem- Soranus, however, seemed to outrightly reject any magical rem-
edies, walking, exercise, phlebotomy, and the administration of edies for epilepsy, as well as the extreme procedures of Aretaeus
pills, which, according to Soranus of Ephesus, upset the stomach (arteriotomy, cauterization, and trephination), and suggested
and provoked vomiting. Other prescriptions to prevent epileptic milder procedures such as scarification and cupping [60].
seizures included consumption of vinegar, provocation of sneezing
before going to bed, wormwood, centauria, and the lichen of horses
6. Conclusions
or mules [50].
On the other hand, Praxagoras of Cos (circa 340) prescribed sev-
The initial connection between magic and medicine inevitably
eral dubious remedies including shaving of the head, rubbing, and
caused epilepsy to be considered a disease of divine origin. The
application of vinegar poultices; special diets with lamb, young
impressive manifestation of the epileptic seizure and the awe it in-
male goats, pigs, young dogs; and the holding of the breath. At
spired in primitives and people of prehistoric civilizations perpet-
the beginning of an attack, he suggested that body parts be com-
uated this belief. Diseases were considered in general the outcome
pressed and rubbed with various substances including the genitals
of invasion by demons or evil spirits, as divine punishment, and, in
of seals, as well as the cauterization and incision of those body
general, the intervention of supernatural powers. On the other
parts [50]. Serapion, one of the main founders of the Empirical
hand, natural causes such as the Moon and the wind were held
School of Medicine, suggested the application of vinegar and rose
responsible for epileptic attacks, and therefore, natural means
oil to the neck and olive oil to the rest of the body along with exer-
were the proper treatment.
cise and other dietary interventions [51].
The Corpus Hippocraticus comprises almost 70 different books
A careful study of Galenic writings leads us to believe that Galen
which date back from the 6th to the 3th centuries B.C. It is, by
did not advise any special treatment for epilepsy. In general, he ad-
far, clear that some writings cannot be attributed to Hippocrates
vised special diets, evacuation of phlegmatic humors, and bleeding
himself; the texts are heterogenous, and some of them are contra-
from the lower arm or the thigh. Moreover, he advised avoiding
dictory and clearly the work of many authors [61].
anything that may provoke an attack as well as engaging in light
The author of the Hippocratic texts, whether Hippocrates him-
exercise [52]. Galen suggested magical remedies involving human
self or not, was the first to dispute the divine origin of the disease
bones [39]: ‘‘I know that some of our people have cured epilepsy
and to establish a more scientific approach to the study of epilepsy
and arthritis in many cases by prescribing a drink of burned (hu-
and its symptoms. Hippocrates inaugurated by his teachings a bat-
man) bones, the patients not knowing what they drank lest they
tle between science, on the one side, and magic beliefs and religion,
should be nauseated.”
on the other. His book On Sacred Disease, as Temkin notes, is the
In his Naturalis Historia, Pliny the Elder (23–79 A.D.) admitted:
first monograph on epilepsy that we possess extant of magic be-
‘‘In cases of epilepsy we spit, that is, we throw back the contagion”
liefs and practices in ancient Greece and of their place in the reli-
[53]. Pliny also recalled various ‘‘magical remedies,” such as rub-
gious development of that civilization [62]. Hippocrates attacks
bing the patient’s feet with menstrual blood [54] or having the pa-
all charlatans, magicians, and wizards who called epilepsy a
tient drink spring water from the skull of a slain, unburnt man [55].
‘‘sacred disease.”
Pedanius Dioscorides (40–90 A.D.) described 45 different sub-
This battle between Hippocratic and ‘‘secular” medicine con-
stances used as remedies for epilepsy [56].
tinued through the Middle Ages to the modern scientific area
Aurelius Cornelius Celsus (25 B.C.–50 A.D.), in his Da Re Medici-
[63,64]. The appearance of Hippocratic medicine, after all, was
na, refers to epilepsy as difficult to treat if it is established at a cer-
not connected to a clear dominance of scientific medicine over
tain age or if the patient is recovering from local paralysis after
other practices. Closer examination of this conflict reveals, in
muscular atrophy has set in. Epilepsy, in his writings, is called mor-
fact, that Hippocratic rationalism is not opposed to the idea of
bus comitialis [57], and as a cure, he prescribed sexual intercourse
the divine and religion in general, but to religious beliefs con-
for boys or the warm blood of slain gladiators in obstinate cases
cerning diseases. In fact, Hippocrates as well as many of his fol-
[58].
lowers were in direct connection with Asklepiads and Asklepios,
Aretaeus suggested for the paroxysm venesection, clysters,
the semigod of medicine. Hippocrates and his followers deeply
ointments, cupping, and the provocation of vomiting. He also em-
respected religion by claiming they were descended from gods
ployed procedures such as bleeding at the elbow and forehead,
[65].
cupping, cutting of arteries, trephination and cauterization of the
During the post-Hippocratic era famous doctors of the Roman
skull, application of rubefacients to the head, and purging with
period such as Galen and Aretaeus systemized the nosology and
strong phlegmagogues. Older patients should be treated, he sug-
suggested mechanisms for the epileptic convulsions. Those physi-
gests, with remedies that help digestion, and have a heating, dry-
cians’ efforts failed to make a contribution equal to the work of
ing, and diuretic effect, particularly castoreum and theriacs [42].
Hippocrates. However, the views of Galen and Aristotle were per-
He also suggested the patient avoid sensations that may provoke
petuated during the Middle Ages, and, under the dominance of
an attack, as well as moderation of sleep. Aretaus also employed
the Catholic Church, religious and magic beliefs regarding epilepsy
extreme therapies for epilepsy such as trephination, now better
continued to exist, obstructing the progress of Science and, conse-
known as craniotomy.
quently, Medicine.

It can also prove effective to apply fire to the head. But first one
should perforate the bone as far as the diploe—afterward one
should use wax and plasters, until the meninx separates from
the bones. With the trephine one must cut the bare all around,
even if they show a slight resistance before they separate spon-
taneously, until, at last, one comes upon the black and thick
Ethical approval
We confirm that we have read the Journal’s position on issues
involved in ethical publication and affirm that this report is consis-
tent with those guidelines.
108 E. Magiorkinis et al. / Epilepsy & Behavior 17 (2010) 103–108
Conflict of interest statement
None of the authors has any conflict of interest to disclose.
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