William G. Lennox: A Remembrance

Summary: William G. Lennox, author of Epilepsy and Related Disorders , had a lasting effect on our understanding of this illness. He postulated that epilepsy was not a unitary condition and that neuronal chemistries differed from one form of the disease to another. A leader in the use of electroencephalography in epilepsy, he described the first nearly pathognomonic EEG pattern and demonstrated specific features for each of the three most common types of seizure. His pioneering investigations into the biochemical basis of epilepsy helped to identify pathological mechanisms in epileptic attacks. Lennox stood alone in his belief, now generally accepted, that the genetics of epilepsy could be understood only through a multifactorial mode of inheritance. The author presents an affectionate portrait of the physician, the teacher and the man, the founder of the Seizure Unit and the unifying force in the study of epilepsy by both professionals and lay persons.     

Mario Gozzano: the work of an EEG pioneer.

The study of the early history of electroencephalography can yield fascinating insights and surprises. A revisit to the work of Mario Gozzano (1898-1986) has proved to be particularly stimulating. His EEG study of 1935 is a classic and should be resurrected from the graveyard of history. Gozzano was an eminent clinical neurologist-epileptologist and chairman of the neurological-psychiatric university departments in Cagliari, Pisa, Bologna and, from 1951 to his retirement, in Rome. He quickly recognized the significance of EEG and produced his major experimental EEG work in the wake of a stay at the Berlin-Buch Brain Institute. His prolonged corticograms of various regions in the rabbit demonstrated striking differences between various cortical areas. Topical cortical strychnine produced spikes (a barely known phenomenon at that time) and the evolution from interictal to ictal spiking. Spikes induced by visual stimuli may be regarded as precursors of evoked potentials. While Hans Berger was a holist ("the brain working as a whole"), Gozzano (influenced by Vogt and Kornmueller) provided EEG support for the localizationists.     

Leonardo da Vinci's contributions to neuroscience

Leonardo da Vinci (1452-1519) made far-reaching contributions to many areas of science, technology and art. Leonardo's pioneering research into the brain led him to discoveries in neuroanatomy (such as those of the frontal sinus and meningeal vessels) and neurophysiology (he was the first to pith a frog). His injection of hot wax into the brain of an ox provided a cast of the ventricles, and represents the first known use of a solidifying medium to define the shape and size of an internal body structure. Leonardo developed an original, mechanistic model of sensory physiology. He undertook his research with the broad goal of providing physical explanations of how the brain processes visual and other sensory input, and integrates that information via the soul.     

John S. Strauss: The life he leads

ABSTRACT

Over a 50-year career, John S. Strauss has taken psychiatry down a remarkable number of new paths which have since turned into fields and have become grounds for new ways of understanding and treating people who suffer from mental disorders. His pioneering emphasis on studying illness over time, patients’ subjective experiences, the multiple dimensions of “outcome”, patients’ active roles in helping themselves, the importance of work, and the value of good writing and narrative are only some of the areas in which he has led the way. No less important were the methods that he used and championed: always rigorous and objective, but sensitive and appropriate to the matters of real interest and to people. A rare congruence exists between his work and his own life, which helped make possible the many gifts he gave to his friends and colleagues, and to patients.     

Donald O. Hebb's synapse and learning rule: a history and commentary

This year sees the anniversary of Donald O. Hebb's birth, in July 1904. The impact of his work, especially through his neurophysiological postulate, as described in his magnum opus, The organization of behaviour (1949), has been profound in contemporary neuroscience. Hebb's life, and the scientific milieu in psychology and neurophysiology which preceded and informed Hebb's work are described. His core postulate, which gave rise to such eponymous expressions as the Hebbian synapse and the Hebbian learning rule, is examined in some detail, as well as the part it played in his higher-order theoretical constructs concerned with neocortical structure and function. Early models which made use of the Hebbian synapse are described, and then illustrative examples are given detailing the impact of Hebb's idea in relation to learning and memory, synaptic plasticity and stability, and the question of persistent cortical activity underlying forms of short-term memory.     

The threshold of the new epileptology: Dr Lennox at the London Congress, 1935

By the time that Dr William Lennox presented his discovery of the diagnostic electrical signature of brain electrical activity in epileptic seizures at the 2nd International Neurology Congress, held in London in 1935, research in epileptology had become mired in conceptual confusion. Not only had the vain quest for extracerebral seizure triggers resulted in decades of negative research, but outré theories such as autointoxication and psychoanalysis had severely damaged and confused the conceptual approach to this condition. Lennox and the Harvard team, in applying the novel technology of electroencephalography helped to clear up this confusion radically. His landmark contribution and the confusion into which epilepsy research had been diverted at that time, is worthy of examination – for this was indeed the threshold of new era of epileptology.     

Clozapine (Clozaril), seizures, and EEG abnormalities

The antipsychotic agent clozapine (ClozarilE) is reserved for the treatment of refractory psychosis. Clozapine has allowed many schizophrenic patients to lead more independent and productive lives, but its use is restricted by side effects. Clozapine has been shown to lower seizure threshold and produce significant EEG changes. Although not a commonly used drug, both clinical neurophysiology technologists and interpreting electroencephalographers need to be aware of the effects of clozapine on the EEG. We review the findings of two patients who developed neurological symptoms and EEG abnormalities that resolved following reduction of clozapine therapy.     

Seizures induced by singing and recitation. A unique form of reflex epilepsy in childhood

A 2-year-old boy of above-average intelligence experienced seizures, manifested by ticlike turning movements of the head, which were induced consistently by his own singing--not by listening to or imagining music. His seizures were also induced by his recitation and by his use of silly or witty language such as punning. The neurologic examination showed only a right-sided Babinski's sign. Seizure activity on an EEG was present in both temporocentral regions, especially on the right side, and was correlated with clinical attacks. A computed tomographic scan was normal. Phenobarbital therapy did not reduce seizure frequency.     

Recollections of Professor Henry Barcroft, F.R.S.

Professor Henry Barcroft, MD, FRS, Emeritus Professor of Physiology in St. Thomas' Hospital Medical School in London died on 11 January 1998, aged 93. He was born in Cambridge on 18 October 1904 where his father, Joseph Barcroft, a famous physiologist, worked with Foster and Langley and subsequently was appointed to the Chair of Physiology. Henry Barcroft followed in his father's footsteps. During his career as Professor of Physiology firstly at The Queen's University of Belfast and subsequently at St. Thomas's Hospital London, he made significant studies on the nervous and humaral control of human blood vessels. His success as a research scientist stemmed partly from his ability to simplify complex phenomena in a way that permitted them to be broken into component parts and tested and partly from his technical ingenuity that permitted simple, inexpensive measurements of difficult physiological variables. Perhaps the most important factor, however, was his ability to bring out and stimulate aptitudes and enthusiasms in others. Completely unselfish himself, he gave individuals every opportunity to develop their talents, and so make themselves known to a wide circle of interested medical scientists. In many ways, his life was a guidebook for young scientists on how to make the most of their opportunities.     

The epileptology of William Aldren Turner.

William Aldren Turner (1864-1945), in his day Physician to the National Hospital, Queen Square, and to King's College Hospital, London, was one of the major figures in the world of epileptology in the period between Hughlings Jackson in the latter part of the 19th century and the advent of electroencephalography in the 1930s. Although he also made contributions to knowledge in other areas of neurology, and with Grainger Stewart wrote a competent textbook on that subject, Turner's main professional interest throughout his career seems to have been epilepsy. On the basis of a series of earlier, rather heavily statistical, personal publications dealing with various aspects of the disorder, he authored what became a well-accepted monograph entitled Epilepsy - a study of the idiopathic disorder, which appeared in 1907, and he also gave the 1910 Morison lectures in Edinburgh on the topic. His writings on epilepsy over a period of three decades consolidated knowledge rather than led to significant advances, but helped maintain interest in the disorder during a rather long fallow phase in the development of the understanding of its nature.     

Alertness and attention: basic science and electrophysiologic correlates.

There has been much research in the electrophysiologic correlates of alertness and attention, but it is fragmented into many subfields. This article integrates current knowledge across multiple disciplines and methodologies to provide a broad overview of alertness and attention. First, terms that are related to alertness and attention are clarified. Then, there is a discussion of basic neuroscience, human neurophysiology, and clinical fields that impact on alertness and attention. Areas discussed include thalamic and neurotransmitter-specific ascending pathways. EEG, event-related potentials, and both physiologic and pathologic states of decreased alertness or attention.     

4-channel 24 hour cassette recorder for long-term EEG monitoring of ambulatory patients.

A 4-channel cassette recorder capable of continuously recording the EEG for 24 h on a C-120 cassette is currently in use at the Montreal Neurological Institute. We have done a limited study on 20 patients with over 2000 h of recording to evaluate the recording system, its limitations and its capabilities, and to develop methodology for its operations. The use of preamplifiers enables one to record the background EEG with a noise level of 3-5 muVpp on 4 channels continuously for 1 day. The electrodes can be hidden in the hair and the preamplifier under the collar, to allow the patient to carry on his normal activities at home and at work. Since the cassette and the batteries can be easily changed, the patient himself can prolong the recording for several days. The cassette can be played back as fast as 60 times on a Minograf EEG machine for compressed analysis or 20 times for more detailed write-out, to obtain a record equivalent to standard EEG recordings. The system was not designed to replace or compete with standard EEG recordings but when used on well defined clinical problems, or in specific research projects, it can enhance the diagnostic or research value of the EEG.     

Henri Laborit and the inhibition of action

Henri Laborit was one of the founders of modern neuropsychopharmacology, having discovered, or participated in, the discovery of chlorpromazine, gamma-OH, clomethiazole, and minaprine. He also put forward a theory regarding the necessity of counteracting the negative consequences of defense mechanisms during anesthesia or behavioral inhibition. The scope of his work covers neurophysiology, pharmacology, psychiatry, and psychosomatics. His independence of spirit meant that most of his research was not done within university settings.     

Pioneering concepts in epileptology: The cerebral dysrhythmia of Frederic Gibbs (1903-92) and William Lennox (1884-1960)

The development of the electroencephalogram and its use in the study of epilepsy supplied the research team of William Lennox and Frederic (Frederick) Gibbs at Harvard University with an entirely new method of studying the epileptic activity of the brain. The abnormal activity, thought to be a “dysrhythmia”, seemed to indicate a central role for inheritance in this condition, and there seemed a more considerable penetration of inheritable epileptic tendency in the community than at first thought. Lennox, who had a long-held interest in eugenics, felt that further study was needed and this he undertook in his famous “Twin Series” exploring epilepsy in identical and non-identical twin pairs. Frederic and Erna Gibbs, however, went on to study the electrical activity accompanying various clinical seizure types. These were the early days of electroencephalography, and mistaken over-emphasis given to various forms of non-specific slower components introduced conceptual errors in both areas of research. However, the overall results of this pioneering research provided very significant advances in epileptology.     

Ellen R. Grass lecture: present at the beginning. Ellen Grass and the evolution of modern concepts regarding EEG and epilepsy

Ellen Grass was a remarkable woman whose efforts on behalf of neurophysiology, epilepsy, and physiological technology contributed importantly to the development of neuroscience in the United States during the middle third of the 20th century. She initially provided an important link between a remarkable group of Harvard physiologists and her husband, Albert, a brilliant engineer whose innovative equipment played a critical role in accelerating advances in neurophysiology and, later, EEG and epilepsy. Mrs. Grass herself observed and personally facilitated much of the clinical and basic neuroscience research during this period, when the modern framework for a scientific understanding of epilepsy and EEG was established. She also supported the development of professional societies relevant to these areas, including ASET, the American EEG Society, the American Epilepsy Society, and the Epilepsy Foundation of America.     

Standardization of neurophysiology signal data into the DICOM® standard

A standard format for neurophysiology data is urgently needed to improve clinical care and promote research data exchange. Previous neurophysiology format standardization projects have provided valuable insights into how to accomplish the project. In medical imaging, the Digital Imaging and Communication in Medicine (DICOM) standard is widely adopted. DICOM offers a unique environment to accomplish neurophysiology format standardization because neurophysiology data can be easily integrated with existing DICOM-supported elements such as video, ECG, and images and also because it provides easy integration into hospital Picture Archiving and Communication Systems (PACS) long-term storage systems. Through the support of the International Federation of Clinical Neurophysiology (IFCN) and partners in industry, DICOM Working Group 32 (WG-32) has created an initial set of standards for routine electroencephalography (EEG), polysomnography (PSG), electromyography (EMG), and electrooculography (EOG). Longer and more complex neurophysiology data types such as high-definition EEG, long-term monitoring EEG, intracranial EEG, magnetoencephalography, advanced EMG, and evoked potentials will be added later. In order to provide for efficient data compression, a DICOM neurophysiology codec design competition will be held by the IFCN and this is currently being planned. We look forward to a future when a common DICOM neurophysiology data format makes data sharing and storage much simpler and more efficient.     

Todd, Faraday, and the electrical basis of epilepsy

PURPOSE: To consider the origins of our understanding of the electrical basis of epilepsy in the light of the Lumleian lectures to the Royal College of Physicians in London for 1849, "On the pathology and treatment of convulsive diseases," by Robert Bentley Todd (1809-1860). METHODS: I have reviewed Todd's neglected Lumleian lectures and his observations and concepts of the electrical basis of epilepsy in relation to the influence of Michael Faraday (1791-1867), his contemporary in London, and in relation to later nineteenth century writings on the subject by Jackson, Ferrier, and Hitzig, all of whom overlooked Todd's lectures. RESULTS: Todd was a clinical scientist as well as Professor of Physiology and Morbid Anatomy, with a special interest in the nervous system, at King's College, where he came into contact with Michael Faraday, the greatest electrical scientist of all time, at the nearby Royal Institution. On the basis of his own clinical and experimental studies and his cutting-edge knowledge of neuroanatomy, neurophysiology, neuropathology, and electrical science, Todd brilliantly developed his concepts of the electrical basis of brain activity and of epilepsy in particular. With his microscope, he perceived each nerve vesicle and its related fibres (neurone in later terminology) as distinct entities for the generation of nervous polarity (force) and its transmission in the white nerve fibres throughout the nervous system by unknown molecular mechanisms. In epilepsy, an increase in electrical tension, especially in the grey matter of the hemispheres, led to periodic, sudden explosive discharges, based on Faraday's concept of disruptive discharges. CONCLUSIONS: Todd was the United Kingdom's first outstanding neurologist and neuroscientist before these disciplines existed. Influenced by Faraday, he proposed and confirmed the electrical basis of nervous discharges in epilepsy more than 20 years ahead of Jackson, Ferrier, and Hitzig, who did not refer to his priority, although Ferrier also worked at King's College, and Jackson also gave his own famous Lumleian lectures on the same subject in 1890. Todd deserves the credit for laying the foundations of our modern understanding of epilepsy.     

Neurophysiological assessment of brain dysfunction in critically ill patients: an update

The aim of this review was to provide up-to-date information about the usefulness of clinical neurophysiology testing in the management of critically ill patients. Evoked potentials (EPs) and electroencephalogram (EEG) are non-invasive clinical neurophysiology tools that allow an objective assessment of the central nervous system’s function at the bedside in intensive care unit (ICU). These tests are quite useful in diagnosing cerebral complications, and establishing the vital and functional prognosis in ICU. EEG keeps a particularly privileged importance in detecting seizures phenomena such as subclinical seizures and non-convulsive status epilepticus. Quantitative EEG (QEEG) analysis techniques commonly called EEG Brain mapping can provide obvious topographic displays of digital EEG signals characteristics, showing the potential distribution over the entire scalp including filtering, frequency, and amplitude analysis and color mapping. Evidences of usefulness of QEEG for seizures detection in ICU are provided by several recent studies. Furthermore, beyond detection of epileptic phenomena, changes of some QEEG panels are early warning indicators of sedation level as well as brain damage or dysfunction in ICU. EPs offer the opportunity for assessing brainstem’s functional integrity, as well as subcortical and cortical brain areas. A multimodal use, combining EEG and various modalities of EPs is recommended since this allows a more accurate functional exploration of the brain and helps caregivers to tailor therapeutic measures according to neurological worsening trends and to anticipate the prognosis in ICU.     

A Forty-Five Year Follow-Up EEG Study of Qigong Practice

A follow-up EEG study was conducted on a subject with 50 years of experiences in Qigong. Resting EEG at present showed frontally dominant alpha-1 as compared to occipitally dominant alpha-2 described in 1962. During the Qigong practice alph-1 enhanced quickly and became far more prominent than 50 years ago. Compared with baseline, these activities remained to be higher at rest after the Qigong practice. These results suggest that extended practice in meditation may change the EEG pattern and its underlying neurophysiology. It remains to be explored as to what biological significance and clinical relevance do these physiological changes might mean.