The great deceiver: the role of convulsive syncope in the history of epilepsy

Because of its high medical and social profile, epilepsy has a voluminous documented history. For centuries it has been the subject of much speculation and attempted explanation. Even from antiquity examples taken from every day life have been used to explore, by analogy, the mechanism of epileptic seizures; and the convulsive phenomena of acute exsanguination have attracted much attention for this reason. A survey of the aspects and the consequences of this exercise in the study of seizure mechanisms shows that, until Jackson and Gowers emphasised the central role of the cortex in human epilepsy, a very complex schema had been constructed to explain epilepsy. This had been based upon erroneous information obtained by analogy from the convulsive phenomena of syncope and exsanguination. Over the millennia this mistaken concept served to divert scientific endeavour in attempts to explain and unravel the bases of epilepsy. It was only little more than a century ago that this concept was finally abandoned.