Epilepsy & Behavior 18 (2010) 424–430

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Epilepsy & Behavior

j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / ye b e h

Fyodor Dostoevsky and his falling sickness: A critical analysis of seizure semiology
Udaya Seneviratne ⁎
Department of Neuroscience, The Alfred Hospital, Melbourne, Australia
Department of Neuroscience, Monash Medical Centre, Melbourne, Australia

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

Article history: Fyodor Dostoevsky is a great Russian writer who had epilepsy. As a consequence, there are many references
Received 24 April 2010 to seizure-related phenomena in his work. His epilepsy syndrome has been a focus of debate. The goal of this
Received in revised form 1 May 2010 article is to delineate his epilepsy syndrome based on a semiological description of seizures, which could be
Accepted 6 May 2010
considered one of the most reliable pieces of circumstantial evidence available. It was hypothesized that
Available online 19 June 2010
seizure-related descriptions in his books were based on his own personal experience. The semiology of
seizures and related phenomena was compiled from Dostoevsky's own work, his letters to family and
Keywords:
Dostoevsky
friends, and reminiscences of his wife and friend. Those descriptions were analyzed in detail to elicit
Epilepsy localizing and lateralizing features of seizures. On the basis of this evidence, it was postulated that
Semiology Dostoevsky had a partial epilepsy syndrome most probably arising from the dominant temporal lobe.
Aura Crown Copyright © 2010 Published by Elsevier Inc. All rights reserved.
Ecstasy
Seizures

1. Introduction 2. Methods

Fyodor Dostoevsky is a towering figure in 19th-century Russian
literature. His work does not simply reflect the contemporary Russian
society, but cuts across cultural and time barriers to portray the
complex nature of the human mind at large. Hence, not surprisingly,
his writings have influenced generations of writers into the 20th
century and continue to draw the attention of literary critics.
Interestingly, Dostoevsky and his literary work have been a focus of
intense attention in the medical profession. His ability to penetrate
into the dark deep corners of the human mind and expose the
complex human psyche has come under the close scrutiny of
psychiatrists and psychologists. However, the greatest interest has
been generated by neurologists and epileptologists. It is well known
that Dostoevsky had epilepsy. Most probably as a result of his personal
experience, he created several characters with epilepsy in his stories.
Dostoevsky has provided vivid descriptions of epileptic seizures,
opening a window to his epilepsy. Several medical authors have
attempted to postulate his epilepsy syndrome based on circumstantial
evidence. This article reviews the history of medical literature on
Dostoevsky's epilepsy and formulates a syndromic diagnosis based on
a critical analysis of semiological descriptions.
⁎ Department of Neuroscience, Monash Medical Centre, Clayton VIC 3168, Australia.
Fax: +61 3 9594 6241.
E-mail address: wusenevi@optusnet.com.au.
To obtain a background understanding of Dostoevsky and his
epilepsy, Dostoevsky's biography and medical literature on his epilepsy
were studied. Semiological descriptions of seizures were acquired from
Dostoevsky's own literary work, his letters to family and friends, and
reminiscences of his wife and friends (see Appendix A). It was
hypothesized that characters with epilepsy and semiological descrip-
tions of seizures in his work were based on his own personal
experiences of seizure phenomena. All semiological details were
critically analyzed to extract localizing and lateralizing features.
Dostoevsky's epilepsy syndrome was reconstructed on the basis of
that evidence.
3. Results
3.1. Biography [1–3]
Dostoevsky was born in 1821 at the Hospital for the Poor in Moscow
to a family of aristocratic heritage. His father, Dr. Mikhail Dostoevsky,
was the director of the hospital and had previously served as a military
surgeon. He was a strict disciplinarian who wanted his children to
achieve noble status. On the contrary, Dostoevsky's mother was a gentle
and religious lady who introduced him to the Bible. In 1837 his mother
died of tuberculosis. The next year he entered the military academy of
engineering. In 1839 his father, who had been suffering from alcoholism
and depression, died.
In 1843, having graduated from the military academy, Dostoevsky
joined the Engineering Corps. However, the very next year he left the
ranks to pursue his long-cherished dream of becoming a professional

1525-5050/$ – see front matter. Crown Copyright © 2010 Published by Elsevier Inc. All rights reserved.
doi:10.1016/j.yebeh.2010.05.004
 U. Seneviratne / Epilepsy & Behavior 18 (2010) 424–430
writer. In 1845, he published his first original work Poor Folk, which
was an immediate success. In 1847 Dostoevsky joined a revolutionary
group known as the Petrashevsky Circle, which upheld the views of
utopian socialism and was involved in anti-tsarist activities. He was
arrested 2 years later and was condemned to death. While waiting on
death row he received a pardon at the last moment and was
sentenced to penal servitude in Siberia.
The period of exile in Siberia marks a watershed in his life.
Dostoevsky shed his revolutionary views and transformed himself
into a religious prophet. He probably had his first major epileptic seizure
while being incarcerated.
Ten years later in 1859 he returned to St. Petersburg. While
struggling with epileptic seizures and emphysema, as well as addiction
to gambling, he produced several literary masterpieces. His 3-year-old
son Alyosha died from status epilepticus in 1878, causing him immense
grief. Dostoevsky published his last novel The Brothers Karamazov in
1879 and 1880. His health had been gradually deteriorating, and in
January 1881 he died of a pulmonary hemorrhage.
3.2. Medical literature on Dostoevsky's epilepsy
Even though there is no debate over the fact that Dostoevsky had
epilepsy, there has been ongoing contention about the type of epilepsy
he had. The medical literature published to date reflects this
controversy.
In 1963, Alajouanine expressed the view that Dostoevsky had
temporal lobe epilepsy [4]. Henri Gastaut, in 1977, postulated that
Dostoevsky had idiopathic generalized epilepsy [5]; however, several
years later he revisited the subject and, having gone through the
literature, concluded that it was likely to be temporal lobe epilepsy [6].
In one of the most comprehensive reviews published on the topic,
Voskuil hypothesized that Dostoevsky had “partial complex epilepsy
with secondarily generalized nocturnal seizures rather than primary
generalized epilepsy” [7]. DeToledo added a new dimension to this
debate by hinting that Dostoevsky may have had nonepileptic seizures
[8]. This conclusion was based on Dostoevsky's last novel, The Brothers
Karamazov, in which the illegitimate son Smerdyakov, who has epilepsy,
kills his tyrannical father and simulates a prolonged seizure to provide
an alibi for him with a view to framing his eldest brother for the murder.
This could be considered a rekindling of Sigmund Freud's age-old
argument that Dostoevsky had “hystero-epilepsy” [9]. In a more recent
article, Hughes formed the view that “Dostoevsky likely had idiopathic
generalized epilepsy but probably with a minor focal component that
quickly became secondarily generalized” [10]. In a well-referenced
article, Baumann and colleagues went one step further in localization
and concluded that “the famous writer might have suffered from mesial
temporal lobe epilepsy” [11].
In the medical literature on Dostoevsky's epilepsy, probably three
areas of controversy are apparent. The age at onset of his epilepsy is
uncertain. Even more uncertain is the epilepsy syndrome. Finally there
is debate as to what he meant by “I have many types of seizures” [2]. In a
complex cold case-type analysis it is easy to cross the boundary from
scientific facts to fictional fantasy. Semiological descriptions are
probably the most reliable evidence available today to reconstruct his
epilepsy syndrome, and these are used in this article.
3.3. Descriptions of seizure semiology in Dostoevsky's work
In Dostoevsky's work the references to seizures range from very
subtle and covert citations to quite dramatic and vivid descriptions.
Some accounts are direct descriptions of seizures, whereas others are
indirect connotations influenced by seizure phenomena. One has to
read his books carefully to educe particularly the subtle references.
Given below is a summary of these descriptions extracted from his
work in chronological order.
425
3.3.1. The Double (1846) [12]
The Double is Dostoevsky's second book published a month after his
first book, Poor Folk. The protagonist, Yakov Golyadkin, is a petty
government official. On a rainy, snowy, winter night while walking
along a street in St. Petersburg, something happens that would change
his life forever. He suddenly sees a duplicate of himself who then
disappears into the darkness. His double gradually invades Golyadkin's
world and completely destroys him finally. As Dostoevsky describes
elegantly, “his nocturnal friend was none other than he himself ...
another Mr. Golyadkin, but absolutely the same as he himself. In short in
all respects what is known as his double.”
Even though there are no frank seizures described in this book, a
close scrutiny reveals its relevance to epilepsy. The entire story is built
on the phenomenon of autoscopy, which has been reported to occur
in several conditions including epilepsy [13–15]. Given the history of
underlying epilepsy it is possible that Dostoevsky experienced ictal
autoscopy which inspired him to create the character, Golyadkin.
3.3.2. Mr. Prokharchin (1846) [16]
Mr. Prokharchin is a short story about a lonely old man living in a
boarding house. One time he was brought back to the boarding house in
a confused state by a cab driver. His blank stare was associated with
some twitching and he was unable to move his tongue. “He uttered a
shriek at the top of his voice, sat up almost in a squatting position and
trembling and quivering all over.” Here Dostoevsky probably is referring
to a generalized seizure. The clever cabby provides a differential
diagnosis as well: “He isn't drunk ... he has probably fainted or been hit
by something or maybe he had a stroke … or maybe he had been taken
with some fit or other.” The observation that he was unable to move his
tongue could be a reference to ictal aphasia.
3.3.3. The Landlady (1847) [17]
The Landlady is a gothic-type short story about Katrina, an enigmatic
young woman; Murin, a possessive old man; and Ordynov, a dreamer
who rents a room from them. Ordynov is attracted to Katrina but is
unable to understand the relationship between her and Murin. Finally it
is revealed that Murin is the ringleader of a smuggling gang and Katrina
is his wife.
Dostoevsky describes a generalized seizure at a crucial stage of the
story. Murin shoots at Ordynov but misses his target as he has an
epileptic seizure. As Dostoevsky describes, “a shot ran out, followed by
a wild almost inhuman shriek ... Murin lay on the floor; he was being
racked by convulsions, his face was distorted with agony and foam
was visible on his twisted lips.”
3.3.4. The Insulted and Injured (1861) [18]
This story is woven around Ivan Petrovich, a writer, and a poor girl,
Nellie, who has epilepsy. Her mother has been abandoned by her
father, Prince Valkovsky. She becomes unwell following an epileptic
seizure and dies later in pride without forgiving her estranged father.
Nellie has several generalized tonic–clonic seizures and Dostoevsky
provides an elegant description: “and suddenly a fearful unearthly
shriek broke from her bosom, her face worked convulsively and she fell
on the floor in a terrible fit.” He also describes postictal confusion and
dysphasia: “After a violent epileptic fit she was usually for some time
unable to collect her thoughts or to articulate distinctly.”
3.3.5. A Disgraceful Affair (1862) [19]
In this satirical short story, Dostoevsky exposes the gaping
disparity between human ideals and actions. Ivan Ilyitch, a high-
ranking government official, decides to attend the wedding of one of
his poor subordinates, as a magnanimous gesture. Things go horribly
wrong, however, and his arrival results in havoc and causes more
misery to the poor clerk. With the unfolding tragicomedy, Ivan Ilyitch
realizes his failure in living up to the ideals he has set for himself.
426 U. Seneviratne / Epilepsy & Behavior 18 (2010) 424–430
Seated at the table after a glass of vodka, Ivan Ilyitch experiences a
series of strange sensations. He feels there are enemies among the
guests. His soul is split in two, one dominated by confidence and the
other by anguish. He becomes dysphasic and experiences lapses in
memory. Then he involuntarily starts spitting repetitively. Finally he
collapses unconscious. Here Dostoevsky is describing either a complex
partial seizure or alcohol-induced disinhibited behavior.
There is another subtle reference to epilepsy in the story. Referring
to Ivan Ilyitch's mental state on his way home following a meeting
with friends, Dostoevsky states: “it is well known that a whole train of
thoughts can pass through one's mind in a flash in the form of some
kind of feeling, without being translated into human language.” This
description is not inconsistent with an aura of temporal lobe origin.
3.3.6. The Idiot (1868) [20]
Prince Myshkin, the protagonist in this story, is perhaps the
ultimate hero created by Dostoevsky. He adds a personal touch to the
character by making the prince epileptic. With this book culminates
his long-term desire to create a Christ-like figure described by him as
“the most beautiful soul.”
The story commences with Prince Myshkin's return to Russia from
Switzerland, where he has been receiving treatment for epilepsy. In
this fateful train journey he meets Rogozhin, his future villain, and
hears about Nastasya, his future love. He inherits an unexpected
fortune and enters the high society of St. Petersburg. The story comes
to a tragic end with the murder of Nastasya by Rogozhin. Finally,
Prince Myshkin, representing good, and Rogozhin, representing evil,
meet near the dead body of Nastasya. True to his Christ-like character,
the prince shows no hatred toward Rogozhin. Having gone through
this traumatic experience he becomes psychotic and is sent back to
the same sanatorium in Switzerland where he was treated for
epilepsy.
Prince Myshkin has several epileptic seizures during the course of
the story. Dostoevsky provides vivid descriptions of the seizure
semiology in this book.
Part 2, Chapter 5, is an important segment of the book in terms of
descriptions of seizure semiology. Leaving a railway station, Prince
Myshkin wanders around in a dreamy state. During this walk he
reflects on his epilepsy, moves in and out of altered conscious states,
experiences forced thinking, and demonstrates some automatic
behavior. He probably experiences several complex partial seizures
which ultimately culminate in a generalized tonic–clonic seizure later
when he meets Rogozhin. In this chapter Myshkin describes his
epileptic aura. Immediately before the convulsion he experiences a
sensation of ecstasy; “the mind, the heart were flooded with an
extraordinary light. All his unrest, all his doubts, all his anxieties were
as if pacified at once, were resolved into a kind of higher calm, full of
serene harmonious joy and hope, full of reason and the final course.”
He describes that the boundless happiness experienced during that
second is so strong that it is worth the whole of his life. This
subsequently came to be known as ecstatic aura in the medical
literature.
The ecstatic aura of Dostoevsky has a predominant religious flavor.
He uses the phrase “prayerful fusion with the highest synthesis of life”
to describe it further. In this chapter, Dostoevsky makes a particular
reference to a conversation the prince had with Rogozhin regarding
his epilepsy. He elaborates on the briefness of the ecstatic aura,
drawing a parallel to two religious remarks. Prince Myshkin compares
this moment to the phrase “there should be time no longer” (from
Chapter 10 of the Revelation of St. John) and the quote that the Prophet
Mohammed was able to survey all the habitations of Allah before the
overturned pitcher full of water is spilt.
After the walk he goes to meet Rogozhin, who is in waiting to kill
the prince. The duo meet on a staircase, and Rogozhin raises his right
hand bearing a knife. Prince Myshkin's mind is focused on the
glittering knife; immediately he has an ecstatic aura culminating in a
generalized tonic–clonic seizure. “An extraordinary inner light
illuminated his soul ... he clearly remembered the beginning, the
very first sound of his terrible howl ... that tore from his breast and
which he could not stop by any effort. After that his consciousness was
extinguished instantaneously and utter darkness ensued. He had a fit
of epilepsy. Convulsing and writhing in spasms the sick man's body
fell down the steps.” Ironically this seizure saves the life of Myshkin
because, having missed his target, the stunned Rogozhin flees.
At this juncture, Dostoevsky goes on to describe the semiology of
generalized seizures further. “It is well known that fits of epilepsy
occur instantaneously. In that instant the face is suddenly distorted to
an extreme degree, especially the eyes. Convulsions and spasms take
possession of the whole body and all the features of the face. A terrible
howl tears from the breast. In that howl everything human seems to
disappear. The sight of a man with falling sickness produces an
unendurable horror that may even contain a mystical element.”
Another interesting incident is described in Part 4, Chapter 7. The
prince walks into a drawing room and his mind becomes fixed on a
Chinese vase. He has a presentiment that he is going to break the vase.
He sits in an armchair beside the vase. He suddenly gets up from his
seat, gives “an incautious wave of his hand and makes some kind of
movement with his shoulder,” which sends the vase crashing to the
floor. He gets a strange sensation of “realization of the prophecy,” The
next moment “everything around him seemed to expand, instead of
horror there was light and joy, ecstasy he began to lose his breath and
... but the moment passed, thank God it wasn't that!” Here Dostoevsky
describes a mixture of partial seizures comprising forced thinking, a
simple partial motor seizure, and an ecstatic aura.
In this book, Dostoevsky also provides an insight into perceptions
of epilepsy in the 19th century. He states that the frequent attacks
experienced by Prince Myshkin have made him a complete idiot. The
prince himself says he is an “invalid” because of the epilepsy.
Professor Schneider, his doctor, is a specialist in epilepsy and
“insanity.” He uses cold water treatment and gymnastics to cure
“idiotism and insanity” and this is the treatment received by Myshkin.
Having spent 5 years in Professor Schneider's care as an inpatient, he
gets better though he is not fully cured.
3.3.7. The Devils (1871–1872) [21]
In The Devils, Dostoevsky examines the rise of nihilism in 19th-
century Russian society. A group of youths plot against the Russian
regime. Among them is a young engineer named Kirilov, an atheist
who suffers from suicidal ideations. He describes an ecstatic aura to
his friend Shatov as “there are seconds—they come 5 or 6 at a time,
when you suddenly feel the presence of eternal harmony in all its
fullness. It is nothing earthly.” The feeling is so intense that you would
be prepared to give your life for them. Shatov asks whether Kirilov has
epilepsy. When he denies it, Shatov warns him that this is the typical
preliminary sensation before an epileptic seizure. As in The Idiot,
Dostoevsky attaches a religious inference to this sensation. Describing
this aura, Kirilov says: “it is as though you suddenly apprehended all
nature and suddenly said yes “it is true it is good!” God when he
created the world said at the end of each day of creation “yes it is true,
it is good.”
3.3.8. A Raw Youth (1875) [22]
In this book, Dostoevsky touches on the conflict between the
illegitimate son and his biological father, a theme that would reach its
climax later in his last novel, The Brothers Karamazov.
Arkady Dolgoruky is the protagonist in this story. In Chapter
8 Dostoevsky describes Arkady wandering along a street in a dreamy
state, which is reminiscent of a similar incident in The Idiot. His mind is
flooded with strange feelings. “In fact I cannot find words for my
sensations, for all this is fantastic after all, poetic and therefore
nonsensical.... Here they are all flitting to and fro, but how can one tell,
perhaps all this is someone's dream, and there is not one real person
 U. Seneviratne / Epilepsy & Behavior 18 (2010) 424–430
here, nor one real action. Someone who is dreaming all this will
suddenly wake up and everything will suddenly disappear.” This is
not a clear description of a seizure. However, these sensations may
have been influenced by a temporal lobe aura, which could present in
the form of a dreamy state.
Another interesting incident is described in Chapter 9. Having left
the roulette table, Arkady finds himself wandering about streets when
he is haunted by a strange feeling of disassociation. He feels
everything around him, including the air he breathes, is from another
planet. “Everything had become suddenly remote, it had all suddenly
become not mine.” This account is suggestive of jamais vu aura in
temporal lobe epilepsy.
3.3.9. The Peasant Marey (1876) [23]
This short story was created by the fusion of two of Dostoevsky's
own distant memories; his life in the prison camp in Siberia and an
incident that occurred when he was 9 years old. One day in the garden
of his family's country house, Dostoevsky heard a distinct and clear
voice shouting “Wolf! Wolf!” He was terrified and was consoled by a
poor serf. The kindness of this peasant made a deep impression in
little Dostoevsky's heart. In the story he mentions that as a child, he
experienced auditory hallucinations, which passed away as he grew
up. Some have considered this to be an epileptic aura [11], but the
evidence in this case is weak.
3.3.10. The Brothers Karamazov (1879–1880) [24]
This last novel of Dostoevsky is a tragic story culminating in
patricide. Fyodor Karamazov, a brutal landowner, is murdered by his
illegitimate son Smerdyakov, who has epilepsy. Smerdyakov executes
a cunning plot to commit the crime and place the suspicion on his
half-brother Dmitri by simulating a prolonged seizure. As the story
unfolds Dostoevsky does not forget to provide descriptions of
Smerdyakov's seizures.
Smerdyakov has frequent seizures sometimes occurring in
clusters. “I once had one that lasted for about 3 days ... it stops and
goes away and then it starts up again.” The unpredictable nature of
seizures is nothing strange to Dostoevsky as mirrored in Smerdya-
kov's words: “it is impossible to anticipate it.” During the murder trial
he describes his seizures: “It is sure and certain the one cannot predict
the falling sickness in advance ... but one may always have the feeling
it is coming.” Here he is most probably referring to an epileptic aura.
This wisdom is expressed further through the words of Ippolit, the
prosecutor: “Smerdyakov had a particular sense of the possible
approach of his fits ... the day and the hour of these fits is of course
impossible to predict, but all epileptics are able to sense beforehand
within themselves a disposition towards them.”
Smerdyakov explains further: “It is going to come now, it is going
to smite me, will I fall down or not?... The unavoidable spasm
suddenly came and grabbed me by throat and so down I went flying.”
The epileptic cry is well described as “a cry of peculiar nature, strange
but one already long familiar to her, the cry of an epileptic falling in a
fit.” The semiology of a generalized tonic–clonic seizure is very
familiar to Dostoevsky as he describes that of Smerdyakov: “they
found him at the bottom of the cellar, in writhings and convulsions
flailing about him and with foam at his mouth.”
3.4. Letters of Fyodor Michailovitch Dostoevsky to His Family and Friends
[2]
Dostoevsky wrote more than 900 letters to his friends, relatives,
and colleagues, a collection of which was published after his death.
This book also contains reminiscences of his relatives and friends. This
correspondence provides extraordinary insight into his life. Among
many other things he talks about his epilepsy and seizures,
particularly in the letters he wrote to his favorite brother Michael
and niece Sofia.
427
He mostly wrote about the recurrent and violent nature of his
seizures. On 16 August 1867 he writes: “the attacks were recurring
every 8 days and it was unbearable to feel and recognize the
destruction of my nerves and brain.” He describes the postictal state
to his niece on 2 July 1870: “I had an attack again. Today my head is
quite muddled and I feel as if I were crazy.” In 1877 he writes: “after
each attack I was bodily and mentally so shattered that for 2 to 3 days I
could not work or write or even read.”
Dostoevsky's close friend Grigorovitch describes: “attacks were
usually followed by a state of great depression which lasted 2 or
3 days.”
Baron Alexander Vrangel, the District Attorney of Semipalatinsk,
who befriended Dostoevsky in his Siberian exile, mentioned in his
reminiscences that Dostoevsky always experienced an indescribable
sense of well-being just before the seizure and he always felt the fit
coming on.
3.5. The diary of Dostoevsky's wife [3]
Anna Grigoryevna, Dostoevsky's second wife, published her
reminiscences after his death. This book provides an insight into the
hitherto unknown inside characteristics of Dostoevsky the man.
Among many others things, she carefully documented Dostoevsky's
seizures and, in some cases, provided descriptions of semiology.
Anna met Dostoevsky for the first time as his newly recruited
stenographer for his novel The Gambler. She noted that Dostoevsky
was looking exhausted and ill. Dostoevsky quite frankly described that
he was an epileptic and had had a seizure a few days before. Later they
fell in love and were married.
Anna noted that Dostoevsky had seizures during sleep and during
the day. She describes two seizures that occurred after their wedding.
After supper he was talking to Anna and her sister at the table.
Suddenly he broke speech in midsyllable, rose, and started leaning
toward Anna. Then he uttered a “horrible inhuman scream or more
precisely a howl and he toppled forward.” He started having
convulsions. Anna noted that after regaining consciousness “he lost
the power of speech. He kept trying to say something but instead of
the word he wanted to say he would pronounce another and it was
impossible to understand him.” This indicates postictal dysphasia. An
hour later he had another violent seizure. The doctors explained to
Anna that the seizures were triggered by excess alcohol intake during
his postwedding visits and dinners. He was better after a few hours of
sleep. But the postictal depressed mood lasted more than a week.
Dostoevsky himself described his postictal depression “as if I had lost
the most precious being in the world, as if I had buried someone.” He
experienced such double attacks in later years, although rarely.
During their stay in Europe, Anna and Dostoevsky visited a
museum to see the famous painting by Hans Holbein, The Dead Christ,
which had a strong impact on Dostoevsky. Anna described how when
he was staring at the painting, the dreadful expression on his face was
similar to what she noted during the first few moments of his seizures.
In fact she anticipated a seizure at that moment, which, however, did
not occur. This description suggests ictal fear. A similar observation is
found later in the book. While Dostoevsky was preparing for his
famous Pushkin Memorial Lecture, Anna was worried about his
having a seizure during the lecture and that people would consider
him a lunatic. She wrote in her diary that “Dostoevsky would always
come to me before fully recovering from an attack as during this
moment he expressed a kind of mystic dread and was soothed by the
presence of someone close to him.” In the same account there is a
possible reference to postictal wandering: “I pictured him having a
seizure; I imagined that before fully regaining consciousness he would
wander through the hotel looking for me.”
Anna cleverly documented that Dostoevsky's memory was
severely deranged by epilepsy. He had great difficulty with memory
for names and faces. She describes one episode where Dostoevsky was
428 U. Seneviratne / Epilepsy & Behavior 18 (2010) 424–430

unable to recognize a famous poet who had been well known to him Table 1
in the past. Once he was embarrassed at a consulate office as he could Semiological information compiled from references.

not remember his wife's maiden name. On another occasion he failed Book Semiological feature Localization Lateralization
to differentiate Anna from her godmother at a meeting. Several such
The Double Autoscopy T N Fa None
incidents were noted by Anna Dostoevsky. Mr. Prokharchin Ictal aphasia TNF L
A notable feature of his stories is seizures that occur at crucial Blank stare, convulsions,
moments. Two such classic examples are found in The Idiot and The distorted face None None
The Landlady Epileptic cry, convulsions,
Landlady in which protagonists are paradoxically saved from the
distorted face, twisted
death because of seizures that occurred at a crucial moment. This is lips, frothing None None
probably based on his own life experiences. In her book, Anna The Insulted and Injured Postictal dysphasia T L
describes Dostoevsky having seizures at important stages of his life. In Epileptic cry, convulsions None None
particular, she vividly describes a very violent seizure leading to a Postictal confusion TNF None
A Disgraceful Affair Repetitive spitting T None
prolonged postictal state when she started having labor pains for their
Memory flashbacks T None
first child. Ictal aphasia TNF L
The Idiot Ecstatic aura T None
4. Discussion Dreamy state T None
Forced thinking F None
Partial motor seizure Focal —
4.1. Analysis of key semiological features Epileptic cry, convulsions None None
The Devils Ecstatic aura T None
Dostoevsky's epilepsy continues to capture the imagination of A Raw Youth Dreamy state T None
epileptologists the same way his books do with readers. In this article Jamais vu T None
The Brothers Karamazov Aura—unspecified Focal —
an attempt was made to reconstruct his epilepsy syndrome primarily
Epileptic cry, convulsions,
on the basis of semiological features extracted from Dostoevsky's own frothing None None
literary work, his letters to family and friends, and reminiscences of Dostoevsky Postictal aphasia T L
his wife and friends. An exhaustive and detailed reading of all sources reminiscences
Ictal fear TNF RNL
was carried out to elicit both overt and subtle references to seizures
Interictal: impaired face
and related phenomena. These findings are summarized in Table 1 recognition T RNL
which is used in this article to postulate his epilepsy syndrome. Interictal: impaired T LNR
Ecstatic aura is the best known epileptic phenomenon linked to naming
Dostoevsky and has historically become synonymous with Dostoevsky's Convulsions None None
Postictal confusion TNF None
epilepsy. This is a rare yet well-described phenomenon in the medical
Postictal wandering T N ET None
literature. Ecstatic seizures are characterized by extreme pleasure and Letters of Dostoevsky to Ecstatic aura T None
contentment sometimes associated with components of cognitive and his family and friends
spiritual experiential phenomena [25]. In a series of presurgical Postictal dysphasia T L
Postictal depression None None
evaluations, 2% reported ictal pleasure, which was localized to
Postictal confusion TNF None
predominantly the temporal basal region but had no lateralizing value
a
[25]. In another series of 11 patients the vast majority demonstrated EEG T, temporal lobe; F, frontal lobe; L, left; R, right; ET, extratemporal.

ictal onset or interictal abnormalities in the temporal lobe [26].

Individual case reports also indicate that ictal ecstasy is of temporal
lobe origin [27–29].
In the series of Hansen et al., 5 of 11 patients reported religious
experiential phenomena [25]. The predominant religious component
of ecstatic aura described by Dostoevsky becomes significant in this
context. Based on this interpretation of current literature, the ecstatic
aura favors the diagnosis of focal epilepsy most probably of temporal
lobe origin in Dostoevsky.
In Part 2, Chapter 5, of The Idiot, Dostoevsky describes an interesting
phenomenon in relation to the conscious state of Prince Myshkin.
Wandering through a street he appears to have two layers of
consciousness, an objective consciousness of the exterior world and
another internal consciousness in which he floats through past
memories. This dreamy state is consistent with the classic “mental
diplopia or doubling of consciousness” of temporal lobe epilepsy
described by Jackson [30]. Using electrical stimulation of depth
electrodes implanted in patients with epilepsy undergoing presurgical
evaluation, Bancaud et al. found that such a dreamy state is generated by
a neuronal network involving both medial and lateral temporal lobe
structures [31]. In a series of patients with ecstatic seizures, about 50%
reported a double conscious state [25]. Hence this is an important clue in
localizing Dostoevsky's epilepsy to the temporal lobe.
The spectrum of seizure-related speech disturbances includes ictal
aphasia, ictal verbalizations, and postictal aphasia. Ictal aphasia is a
rare yet complex phenomenon in which the seizure activity usually
originates from the dominant temporal lobe [32]. In postictal aphasia,
the seizure focus is in the temporal lobe of the dominant hemisphere,
while a minority demonstrate bilateral speech representation [33].
Dostoevsky's familiarity with both ictal and postictal aphasia favors a
diagnosis of temporal lobe epilepsy. His wife also documented
Dostoevsky's postictal dysphasia in the form of paraphasic errors.
Autoscopy forms the cornerstone of the story plot in The Double. It
is characterized by the hallucinatory experience of seeing one's own
body (one's double) in the external visual space. On the contrary, in an
out-of-body experience, one feels that he or she is leaving the body
and viewing it from another location outside. Both are considered
autoscopic phenomena.
Autoscopic phenomena can be observed in persons with various
pathological conditions as well as in healthy individuals. It has been
well described as an epileptic phenomenon [13–15]. A study
comparing phenomenological neuropsychological and neuroimaging
correlates of autoscopic phenomena localized the area of brain
dysfunction to the temporoparietal junction [13]. Another study
reported autoscopic phenomena in 6.3% of patients with epilepsy
interviewed, and 86% had a seizure focus in the temporal lobe [14].
However, the authors did not find any lateralizing value in autoscopy.
Dostoevsky's vivid descriptions of autoscopy in The Double probably
indicate his own experiences from focal seizures.
In her reminiscences, Dostoevsky's wife refers to a fearful expression
on his face at the onset of his seizures. This is a significant remark even
though Dostoevsky himself did not describe this in his own work. The
amygdala is a key region in the generation of ictal fear [34]. Intense fear
is caused by electrical stimulation of the right amygdala rather than the
left [35]. In a review of 144 reported cases of ictal fear, the seizure focus
 U. Seneviratne / Epilepsy & Behavior 18 (2010) 424–430
was found to be lateralized to the right side in 68%. It was localized to the
temporal lobe in the vast majority [36].
Anna Dostoevsky made an interesting observation about her
husband's striking difficulty in recognizing familiar and famous faces
as well as remembering names. A study involving patients with
temporal lobe epilepsy before and after temporal lobectomy revealed
that lesions in the right anterior temporal lobe resulted in impairment
of the recognition of familiar faces and the learning of new faces. On
the contrary, lesions of the left temporal lobe caused difficulties in
recalling names of known people but did not affect face recognition
[37]. Another study found more severe naming and word-finding
difficulties in patients with left temporal lobe compared to right
temporal lobe epilepsy [38].
In her reminiscences Anna Dostoevsky also makes references to
confusion and wandering following the seizures of her husband [3].
This observation has an important localizing value. Postictal wander-
ing has been found to be significantly more common in temporal lobe
epilepsy than in extratemporal lobe epilepsy [39]. In a series of 148
video-recorded frontal and temporal lobe seizures, postictal confusion
was more commonly encountered in temporal lobe seizures, whereas
fencing posture was more commonly seen in frontal lobe seizures
[40]. Hence, postictal confusion and wandering favor the diagnosis of
temporal lobe epilepsy for Dostoevsky.
Several other semiological symptoms are briefly and sometimes
vaguely mentioned in Dostoevsky's writings. Repetitive spitting is a
rare automatism seen in patients with right temporal lobe epilepsy
[41]. Forced thinking has been reported in frontal lobe epilepsy [42].
Dysmnestic symptoms such as memory flashbacks and jamais vu are
recognized as experiential phenomena in temporal lobe epilepsy.
Writing a letter to his niece, Sofia Alexandrovna, in October 1868,
Dostoevsky says: “I suffered much from epileptic and other nervous
attacks”[2]. This statement sparked speculations that he was referring
to nonepileptic seizures [6]. However, the analysis of his writings
indicates semiological features of different auras. It is more likely that
he was referring to different auras, failing to recognize that these were
related to his epilepsy. Multiple types of auras in an individual patient
are well recognized in partial epilepsy [43].
There, however, remain two unresolved issues with respect to
Dostoevsky's seizure semiology and epilepsy syndrome. First, even
though he described auras, particularly the ecstatic aura in his stories,
surprisingly none are described in his writings about himself. A
careful review of Dostoevsky's letters to family and friends [2], as well
as his diaries and notebooks published after his death [44], did not
contain any references to auras even though there were numerous
accounts of his epilepsy. This finding, to some extent, contradicts the
hypothesis of partial epilepsy, as previously indicated by other
authors such as Gastaut and Hughes [5,10].
Second, the seizures most well described by Dostoevsky's wife and
friends are generalized convulsions. A particularly good example is
the seizure after his wedding characterized by an epileptic cry
followed by loss of consciousness and tonic–clonic convulsions [3].
These seizures give the impression of idiopathic generalized epilepsy.
Hence, one may argue that Dostoevsky might have had the rare
combination of partial and idiopathic generalized epilepsy. Coexis-
tence of partial and idiopathic generalized epilepsy has been reported
as a rare phenomenon with a prevalence of 0.2% [45].
4.2. Reconstruction of Dostoevsky's epilepsy syndrome
Semiological features analyzed in this article suggest that
Dostoevsky had a partial epilepsy syndrome manifesting with simple
partial, complex partial, and secondarily generalized tonic–clonic
seizures. His postictal state was characterized by dysphasia, confusion,
wandering, and depression. He had interictal memory disturbances
particularly in the form of poor recognition of faces and recall of
names. Most of the semiological features localize the seizure focus to
429
the temporal lobe. A more precise localization to the mesial or lateral
temporal lobe is difficult with the available data. Ictal and postictal
speech disturbances help lateralize the seizure focus to the left
hemisphere. There are no clues in the sources analyzed in this article
to the etiology of his epilepsy. However, given the aggressive nature of
his epilepsy, a remote symptomatic etiology is a possibility. Whether
he had coexistent idiopathic generalized epilepsy remains debatable.
More than a century ago Hughlings Jackson (1835–1911)
published the first well-known and scientific semiological descrip-
tions of epileptic seizures. It is fair to say that Fyodor Dostoevsky, who
lived in the same era, provided the most artistic and colorful
descriptions of epileptic seizures based on his own experience. This
could be considered a rare and honorable contribution of a
nonmedical author to the field of clinical epileptology.
Conflict of Interest
The author declares that he has no conflicts of interest.
Appendix A. The books by Dostoevsky studied for this article
The Double A Disgraceful Affair
The Idiot The Peasant Marey
The Devils An Honest Thief
The Brothers Karamazov An Uncle's Dream
A Raw Youth A Novel in Nine Letters
The Insulted and Injured Another Man's Wife
Crime and Punishment The Heavenly Christmas Tree
The Gambler The Crocodile
Poor Folk Bobok
The House of the Dead The Dream of a Ridiculous Man
Notes from Underground Polzunkov
The Eternal Husband White Nights
Mr. Prokharchin A Gentle Creature
The Landlady A Christmas Tree and a Wedding
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