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Neo-Babylonion Period: Sakkiku "All Diseases" 

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Neo-Babylonion Period: Sakkiku "All Diseases" 

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The tablet presented is Tablet 26 which is part of a 40-series collection compromising the ancient Babylonian diagnostic manual known as Sakikku, meaning “all diseases”. Sakikku is structured into 6 chapters, with tablet 26 serving as the initial entry in the chapter dedicated to epilepsy. This tablet details the symptoms of epilepsy and various presentations of epileptic conditions¹.

The extensive history of epilepsy can be traced back to a 4000-year-old Akkadian tablet discovered in Mesopotamia. The tablet bears the inscription describing a person exhibiting symptoms like “his neck turning left, hands and feet are tense, his eyes are wide open, and from his mouth froth is flowing without him having any consciousness.” Nearly a thousand years later, the Late Babylonians compiled the diagnostic manual Sakikku. Within this guide, the Babylonians outlined various types of seizures. Categorizing them based on their manifestations. The tablet introduced terms related to epilepsy, such as miqtu (fall), hayyatu (fit), and sibtu (seizure). This basic nomenclature emphasizes that the ancient world possessed some knowledge of epilepsy. These rapid contractions were believed to be caused by evil spirits evading the body, the treatment often involved spiritual intervention¹.

Sources:

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8051941/

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The Epilepticus Sic Curabituris (“the way to cure an epilepticus”) is a miniature painted at the end of the 12th century and featured in a Latin manuscript collection. In this depiction, an individual with epilepsy is depicted undergoing trepanation and cauterization simultaneously¹.

This miniature stands as one of the earliest artistic portrayals of epilepsy surgery. In the Middle Ages, and potentially earlier, cauterization was viewed as a secondary measure utilized when trepanation failed to effectively control seizures¹. The operation was rarely done for medical reasons in wartime instances, such as a lifting section of the skull cap that had penetrated the inner part of the skull due to an injury, thought to be causing epileptic seizures. The surgeon aimed to elevate the bone fragment thereby eliminating the source of the epilepsy. However, trepanation and cauterization were mostly carried out for superstitious reasons. There was a belief that opening the skull cap would release the demons associated with the illness, along with poisonous gases or disease-causing fluids².

Sources:

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https://www.researchgate.net/figure/Epilepticus-Sic-Curabitur-the-way-to-cure-an-epilepticus-Sloane-manuscript_fig1_255735217

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https://historymedicine.blogspot.com/2008/12/epilepticus-sic-curabitur.html

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First illustrated Turkish medical book: 

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First illustrated Turkish medical book: 

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The first medical book of the 15th century, Cerrahiyetul Haniye (Imperial Surgery), was written by a famous Turkish surgeon named Sefereddin Sabuncuoglu. This illustration from the book depicts Sabuncuoglu employing surgical instruments to perform cauterization on the cranium. Although it was written in 1465 it was discovered much later in 1939¹.

This procedure aimed to address the unpleasant odor in the nose of the patient, with the frontal region being the surgery site. In instances of epilepsy, Sabuncuoglu initially suggested employing herbal mixtures to address the unpleasant odor in the nose, if this approach proved ineffective, he advocated for cauterization on the forehead. It's conceivable that patients experiencing displeasing odors in their noses might have encountered olfactory hallucinations as epileptic auras linked to temporal lobe epilepsy. This is a symptom acknowledged since Galen’s era¹.

Sources:

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https://www.researchgate.net/figure/Epilepsy-treatment-from-the-surgical-atlas-Cerrahiyetuel-Haniye-Imperial-surgery-Drawn_fig2_255735217

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An Egyptian insight: Sunlight and femininity 

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An Egyptian insight: Sunlight and femininity 

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The Pharoah Akhenaten, illustrated with feminine curves, is shown venerating the sun disk, the sole deity in his newly established monotheistic pantheon¹.

He is portrayed with feminine features because they believed that temporal lobe epilepsy affects the release of hormones and sexual development. Furthermore, they thought that individuals afflicted by temporal lobe epilepsy were susceptible to seizures when exposed to sunlight, frequently leading to hallucinations and religious visions. Akhenaten ruled Egypt’s New Kingdom with sun and light-based monotheism, which eventually declined in the 12th century¹.

Sources:

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https://www.biblicalarchaeology.org/daily/news/epilepsy-tutankhamun-and-monotheism/

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Another cure for epilepsy: Removing the "Stone of Madness" 

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Another cure for epilepsy: Removing the "Stone of Madness" 

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One of the most renowned representations of apparent trephining for mental illness can be found in early Flemish Renaissance paintings. Hieronymus Bosh’s artwork titled “The Cure for Madness (or Folly)”, alternatively known as “The Stone Operation”, illustrates a surgical incision being performed on the scalp¹.

In medieval times, a prevalent belief held that a “stone of madness” or “peiree de foille” was present inside the skulls of those suffering from mental disorders. A widespread remedy to alleviate their madness involved extracting this presumed “stone”. Charlatans in the medical field traveled through the countryside, offering to conduct such surgeries. An example of the surgery illustrated in the image above, was also common in treating epilepsy².

The Surgical text “Quattuor magistri” from the 13th century suggested the practice of opening the skulls of individuals with epilepsy to allow the escape and evaporation of humors and air. However, by the late 17th century, trephination for epilepsy started to be seen as an extreme measure¹.

Sources:

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https://thereader.mitpress.mit.edu/hole-in-the-head-trepanation/

(2)

https://journalofethics.ama-assn.org/article/cure-folly-or-removing-stone-madness/2000-03#:~:text=During%20medieval%20times%2C%20many%20people,offering%20to%20perform%20the%20surgery.

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Current Treatments: Deep Brain Stimulation 

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Current Treatments: Deep Brain Stimulation 

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Approved by the FDA to treat epilepsy if other remedies fail, deep brain stimulation is a technique that uses a permanently implanted wire in the brain to transmit electrical pulses. This treatment doesn’t fully get rid of seizures caused by epilepsy but reduces the frequency significantly¹.

The process of deep brain stimulation for epilepsy requires a single surgery performed while the patient is under anesthesia. In this surgical procedure. The surgeon inserts a slender wire lead with multiple electrodes at the tip into a deep brain region, the thalamus. Following confirmation from an imaging exam that the electrodes are placed correctly, a pulse generator (battery-operated) is implanted close to the collarbone under the skin. Wires extending from the brain electrodes are situated under the skin and linked to the generator. The device is programmed to deliver continuous electrical pulses to the brain¹.

The associated risks with deep brain stimulation surgery are relatively minimal when compared to other brain surgeries. Additionally, if this treatment proves ineffective for a patient, it is reversible¹.

Source:

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https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-deep-brain-stimulation-may-reduce-seizures-caused-by-epilepsy/

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The father of all medicine, Hippocrates presents as an ideal docent to guide you through this mini-exhibit.  He wrote a book called “On the Sacred Disease” (400 BC), in which he stated that he believed epilepsy is caused by excess phlegm entering the bloodstream and is nothing divine in nature in comparison to other diseases¹.

Hippocrates, pioneering the scientific investigation of epilepsy, was the first to propose a potential treatment for the condition. He asserted that both brain dysfunction and hereditary factors contribute to the etiology of epilepsy. He also coined the term "grand mal"¹.

He viewed epilepsy as a treatable condition unless it persists for an extended period. In his book, he introduced the first neurosurgical procedure called a craniotomy. He recommended conducting a craniotomy on the opposite side of the brain affected by the seizure to protect patients from the “phlegmad”, believed to be causing the disease¹.

Sources:

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https://www.intechopen.com/chapters/66382