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Some of the most important early detailed descriptions of epilepsy are traced back to the publications and animal studies of Charles-Édouard Brown-Séquard. Séquard was a French physiologist and neurologist who largely contributed to an apex of epilepsy advances in the mid 19th century alongside his hormone-related discoveries¹.

Séquard described the seizures following spinal hemisection at length, comparing the convulsions and simultaneous contractions of different body parts between animal episodes and human episodes¹. Séquard rooted epilepsy and his concept of the nervous system in the occurence of inhibition and "dynamogenesis", or excitation to explain how actions from a distance could inhibit or excite other areas of the nervous system¹.

The image above is a surviving letter from 1885 handwritten by Séquard for a patient regarding an upcoming visit.

Source:

(1)
file:///C:/Users/isabe/Pictures/Brown-Sequards_spinal_epilepsy.pdf
(2) (Image)
https://www.sophiedupreautographs.com/StockItem.aspx?s=39166

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In tandem to major localization discoveries, the 19th century was also a critical period during which the physiological realities of epilepsy were being questioned. Once paired with demonic possession and exorcism, epilepsy adopted a new classification by the early 19th century as a condition of madness and neuroticism1,2. Epileptic patients were associated with those battling psychiatric disorders until a vascular explanation was proposed—was epilepsy caused by acute anemia or acute congestion of the brain³? Robert Bentley Todd's refutation of this proposal would establish the electrical basis of epilepsy and lay the groundwork for today's breadth of knowledge on nerve cell disruption.

During the 1830s and 1840s, the electromagnetism teachings of Michael Faraday began to gain popularity out of the Royal Institute in the UK, and Faraday's studies surrounding the concept of polar force were followed by a young physician-scientist named Robert Bentley Todd⁴. Todd explained epileptic convulsions as an unnatural development of nervous force that disturbed the function of the cerebrospinal center, a parallel he had drawn from the 'disruptive discharge' Faraday demonstrated with a Leyden jar⁴. Prior to the discovery of the motor cortex, Todd identified how lesions can produce contralateral limb convulsions as well, moving convulsions beyond previous links with hysteria⁴. Better treatment approaches were on the horizon for epileptic patients!

The image above shows the statue of Robert Bentley Todd sculpted by Victorian artist Matthew Noble in 1862. Today, Todd's monument sits outside the King's College Hospital in London to commemorate his pivotal contributions to science and medicine⁵.

Source:
(1)
10.1007/978-3-319-06293-8.pdf (springer.com)
(2)
https://pubmed.ncbi.nlm.nih.gov/6383300/
(3)
https://www.who.int/mental_health/neurology/Epilepsy_disorder_rev1.pdf
(4)
https://reader.elsevier.com/reader/sd/pii/S1474442204008427?token=D9C100C80C7766136A352ED24974B64E77A24FB006AC409D7261F6008A6337334673EB5D6541223D1FDEED2DB7DFC59A&originRegion=us-east-1&originCreation=20220404141356
(5)
http://himetop.wikidot.com/robert-bentley-todds-monument
(6) (Image)
https://www.researchgate.net/figure/Statue-of-Robert-Bentley-Todd-outside-Kings-College-Hospital-that-he-founded-Originally_fig1_51038960

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Samuel Wilks will be the best guide to walk you through this exhibit. Wilks was a British physician and pathologist in the 1800s probably best known for his work at Guy's Hospital from 1856 to 1885 and the important diagnosis distinctions he made between conditions previously ruled similar or congruent in mid-19th century medicine1,2. Wilks went onto become the President of the Royal College of Physicians of London and ultimately laid the groundwork for the future development of antiepileptic pharmaceuticals².

After gaining insight into the nature of epilepsy, Wilks used potassium iodide to treat patients until he concluded potassium bromide would perform better in treating goiters and glandular swellings in the same cases². Wilks began using potassium bromide in 1859 to once again treat all the forms of epilepsy he encountered at Guy's Hospital, then published his findings in the Medical Times and Gazette in 1861. The usage of potassium bromide grew in popularity soon after, as reports of successful epilepsy recoveries spread around the medical community².

During the 1850s, when the electrical premise of epilepsy was still a recent development and the exact causes of different forms of epilepsy had yet to be pinpointed in the nervous system, Wilks made incredible progress in treating a condition that was still being unpacked. Most importantly, Wilks' pathology demonstrations and treatment hypotheses collectively made a huge contribution to contemporary understandings and treatments of epilepsy².

Source:
(1)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2900981/
(2)
https://www.rcpe.ac.uk/college/journal/sir-charles-locock-and-potassium-bromide

(3) (Image)
https://history.rcplondon.ac.uk/inspiring-physicians/sir-samuel-wilks

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The Contemporary Emergence of Deep Brain Stimulation (DBS) 

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The Contemporary Emergence of Deep Brain Stimulation (DBS) 

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The video above introduces the benefits of deep brain stimulation (DBS) as a method to target the refractory seizures that come with many forms of epilepsy1,2.  After Wilks' breakthrough with potassium bromide, managing the electrical circuitry Todd initially described became a challenge during the development of anti-epileptic drugs (AEDs) in subsequent years. The increasing specificity of AEDs was monumental in that proteins of interest could be targeted to modulate select mechanisms of action; however, AEDs were questioned after long-term chronic use increased the risk profile of patients².

Using the nervous system and AED knowledge previously applied to countless epilepsy cases, DBS was able to be developed for patients who did not experience great outcomes with scheduled AED treatment. Utilizing electrical impulses to modulate our nervous system today was made possible by early notions of nerve fibers and electrical signaling from the 19th century.

Source:

(1)
https://my.clevelandclinic.org/health/treatments/21079-deep-brain-stimulation-for-epilepsy
(2) (Video)
https://www.youtube.com/watch?v=aP2q8HgD4pI&ab_channel=MayoClinic

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Deep Brain Stimulation Treatment for Epilepsy – Mayo Clinic

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Social Improvement at The National Society for the Employment of Epileptics (NSEE)

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Social Improvement at The National Society for the Employment of Epileptics (NSEE)

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By 1894, a major social stride was taken for individuals with epilepsy in contrast to the previous sentiments towards epilepsy symptoms that were once viewed as a possession or psychiatric disorder.

In southeast England, a property originally known as Skippings Farm was bought by a group of neurologists who became the Epilepsy Society and turned a farm into The Chalfont ‘colony’¹. Freeing the first group of epilepsy patients from the workhouses and asylums of Victorian England meant these patients had a chance to be people again and engage in life¹. Transitioned individuals were able to work indoors and outdoors and develop skills in contrast to being bogged down by heavy medications and physician orders; however, this change was not an immediate, sharp switch from an utterly dystopian institution to a utopian colony1,2.

Many years of advocacy and working with the National Hospital for the Paralysed and Epileptic in London allowed more medical professionals to understand the benefit of intellecutal and physical engagement over time¹. Initially, only patients who were considered to display "reasonable" behavior could join the Epilepsy Society's venture yet this group would serve as the catalyst for eliminating the stigmatization of epilepsy in the coming decades¹.

The above image is an original photograph of the Epilepsy Society's 1896 Eleanor House opening ceremony in Buckinghamshire, England.

Source:

(1)
https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(17)30164-3/fulltext
(2) (Image)
https://epilepsysociety.org.uk/what-we-do/about-epilepsy-society/history-epilepsy-society

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Navigating the structures of peripheral and central nerve tissue was enhanced with more frequent use of animal studies in the mid to late 19th century. Robert Remak is a notable figure among a group of influential researchers who began making accurate descriptions of the nervous system in the 1830s that would help improve epilepsy treatment.

Remak was a Jewish Polish-German embryologist, physiologist, and neurologist who conducted studies with rabbits and calfs at Charite Hospital in Berlin to further investigate nerve function¹. In 1838, Remak described an important connection between neurons and nerve fibers that was groundbreaking. This connection was controversial in the beginning given Remak's scientific peers who were also respected in the field initially rejected the idea and adhered to the dominating belief that nerve fiber endings were merely surrounded by ganglionic bodies without any interconnection2,3. Remak went onto describe distinct unmyelinated fibers present in postganglionic sympathetic fibers and in some preganglionic sympathetic and parasympathetic fibers known today as C-fibers or "Remak's fibers"².

The image above is an illustration from Remak's 1836 research publication laying out fiber damage, constriction, and morphological comparisons between fibers².

Source:

(1)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3675270/pdf/415_2012_Article_6761.pdf
(2) (Image)
file:///C:/Users/isabe/Pictures/2015_chvatal_valentin_remak_purkyne.pdf
or
https://www.researchgate.net/publication/272075992_Discovering_the_Structure_of_Nerve_Tissue_Part_2_Gabriel_Valentin_Robert_Remak_and_Jan_Evangelista_Purkyne
(3)
https://faculty.washington.edu/chudler/hist.html

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The National Hospital for Neurology and Neurosurgery

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The National Hospital for Neurology and Neurosurgery

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In London, the National Hospital for Neurology and Neurosurgery was the prime location where epileptic patients were treated by leading physicians who had access to much of the cutting edge research of the 19th century related to epilepsy and the nervous system¹. The majority of epileptic patients (80.3%) recorded from 1870 to 1895 had an average hospitalization length between one to six months, much longer than today's average hospitalization length of a few days in a standard epilepsy monitoring unit (EMU)1,2.

The National Hospital was renowned as a medical institution created strictly for the active treatment of diseases of the nervous system which set a precedent for the formation of similar hospitals in contrast to the less helpful objectives of neighboring mental asylums¹. Serious cases were seen over the years, as the majority of patients were of the working class who had to prioritize their jobs over their health and who required the fastest possible recovery for their return to a typically laborious profession in order to survive and ensure their family's survival¹.

The image above is a photograph from 1900 of the Operating Theatre Queen Square in the National Hospital for Neurology and Neurosurgery. For physicians and scientists, having the opportunity to study cases of severe epilepsy largely contributed to the growth of subsequent treatment research¹.

Source:

(1) (Image)

https://link.springer.com/content/pdf/10.1007%2F978-3-319-06293-8.pdf
(2)
https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/epilepsy/emu.html