Journal of Neurolinguistics Volume 6 Issue 4 1991 [Doi 10.1016%2F0911-6044%2891%2990010-G] Lebrun,...

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J. Neurolinguistics,

Volume 6, Number 4,

pp 361-370, 1991

0911~6044191 $3.00+.00

Printed in Great Britain

0 1992 Pergamon Press plc

Language and Epilepsy:

an Introduction

Yvan Lebrun

School of Medicine

Vrzje Universiteit Brussel

INTRODUCTION

From time immemorial epilepsy has been considered a special disease, a weird

illness, a strange malady. The Ancients thought that it was inflicted on humans by the

gods. Hence the title The Sacred Disease

which Hippocrates (460-380 B.C.) gave

to the book in which he dealt with epilepsy. However, the Greek physician himself

did not think that the ailment had a divine origin. I am about to discuss, he wrote,

the disease called sacred. It is not, in my opinion, any more divine or more sacred

than other diseases, but has a natural cause, and its supposed divine origin is due to

mens inexperience, and to their wonder at its peculiar character.

Hippocrates view was not accepted, and for centuries epilepsy continued to be

regarded as a sickness of supernatural origin. The Romans called it morbus sacer, i.e.

the sacred disease. In French it was referred to as the mal sacre, ma1 (de) sainct, ma1

divin or haut mal. The Germans spoke of heilige Krankheit or heiliges Weh (= sacred

disease).

In ancient Rome, if someone had a seizure during a comitia, i.e. an assembly of the

people, the assembly had to be dispersed, because the occurrence of the seizure was

considered an ominous sign. Epilepsy therefore was often called morbus comitialis.

The adjective comitial is still used in French medical jargon to refer to epilepsy.

In olden time epileptics were considered to be possessed of a demon. In Greek

epileptos meant not only epileptic but also controlled by a spirit. As Hobbes put it in

Leviathan (1651), epileptics were esteemed demoniac. This was also the opinion

of Jean Taxi1 (1612):

Tous les demoniaques sont Cpileptiques (All demoniacs are

epileptic). Accordingly, epilepsy was called le mauvais ma1 (= the wicked disease) in

French.


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362 Journal of Neurolinguistics, Volume 6, Number 4 1991)

The Gospels recount that Jesus cured an epileptic boy by exorcizing him. Here is

how Luke (9: 37-42) tells the story, which is also to be found in Matthew (17: 14-18)

and in Mark (9: 17-27):

And it came to pass, that on the next day, when they were come down from the hill, much people

met him. And, behold, a man of the company cried out, saying, Master, I beseech thee, look

upon my son: for he is mine only child. And, lo, a spirit taketh him, and he suddenly crieth out;

and it teareth him that he foameth again, and bruising him hardly departeth from him And

Jesus answering said, Bring thy son hither. And as he was yet coming, the devil threw him

down, and tare him. And Jesus rebuked the unclean spirit, and healed the child, and delivered

him again to his father.

In old Egypt, epileptics were advised to eat excrements of donkeys diluted in wine.

The purpose was to sicken the inside demon and cause him to leave ones body.

Epilepsy was also ascribed to the pernicious influence of the moon. It was therefore

called morbus lunaticus in Latin, ma1 lunatique in French and maanziekte (= moon

- -

sickness) in Dutch. In Greek seleniakos, an adjective derived from selene (= moon),

meant epileptic. The chapter in the Gospel by St Luke and the chapter in the Gospel

by St Matthew where the healing of an epileptic boy by Jesus is recounted, are entitled

in the King James version He heals a (or the lunurick. In the 19th century a beverage

supposed to be efficacious against epilepsy was given twice a year to sufferers in Tain

on the river Rhone in France. The drug had to be drunk when the moon was full.

The association of epilepsy with the moon and more specifically with moon cycles

(which are about four weeks in duration) may in part be due to the fact that in a number

of epileptic females attacks occur only, or increase in frequency, at the menstrual

period. It may be recalled in this connection that the word menses, which means

menstruation, originally meant months and is akin to Greek men (month) and m&e

(moon).

Epileptics were often debarred from a number of positions or privileges. Not until

the reformation of the canon law in 1983 could an epileptic be ordained a priest. In

early Christian times, epileptics were refused the holy communion. In antiquity the

sale of a slave was void if the slave turned out to be epileptic.

The disease was often considered contagious and hereditary. People therefore used

to spit on epileptics, to protect themselves from the illness, which for this reason was

called morbus insputatus (= the disease you spit at) in Latin. In various countries,

until recently epileptics were not allowed to marry.

Epileptics were thought liable to misbehave or commit misdeeds. Down to the end

of the 19th century, misdemeanour and even crimes were frequently ascribed to

epilepsy.

Epilepsy was dreaded. Therefore its name was taboo in many quarters. Euphemisms

had to be used instead, which often had a propitiative function. For instance, the


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Language and Epilepsy 363

French spoke of the beau ma1 (= nice disease) or bon ma1 (= good disease). At times,

they simply referred to the illness as le ma1 (= the disease).

Epilepsy was - and still is - a serious handicap. Hence its Latin name of morbus

sonticus (= severe illness). The French spoke of grand(e) mal(adie) (= the fateful

disease).

Several saints used to be invoked against epilepsy. One of them was St Valentine

(Fig. 1). Indeed, he was considered the patron saint of the epileptics, and epilepsy was

often called ma1 St Valentin (= St Valentines disease) in French. The Germans used

St Veltinskrankheit, St Veltinsplage (= St Valentines plague), or St Veltinsarbeit

(= St Valentines toil). In Dutch sintvelten became a synonym of epilepsy. And so did

Sankt Veltin in German. One could curse somebody out with the words: Ich wolt,

dasz er Sanct Veltin het (= I wish he had St Valentine, i.e. epilepsy). The Dutch

idiom iemand naar Sint Velten wensen means to call on fate to visit someone with

Saint Valentine, i.e. with epilepsy, hence to curse someone.

According to some etymologists, the name of the Latin saint Valentinus, after it had

become Veltin /feltin/ in German, was equated to the homophonous phrase fallt hin,

i.e. (he) falls down. Since falls were considered the main symptom of epilepsy, St

Valentine came to be associated with the disease.

There is another possibility, however, St Valentinus is reported to have delivered

the Roman emperors son from an evil spirit. Maybe the child had epilepsy, or else

chorea. The two diseases were often confused. Chorea used to be called St Vitus

dance. The Dutch spoke of St Vitusdans and the Germans of St Veitstanz. In the

southern part of Germany the name Valentinus became Valtl and was therefore occa-

sionally confused with Veit /vait/. Sankt Veit being mistaken for Sankt Valtl and

chorea being mistaken for epilepsy, Sankt Valtl, i.e. St Valentine, came to be

associated with epilepsy.

At Rouffach (or Rufach) near Colmar in Alsatia, there was a church with a shrine

containing relics of St Valentine. In the Middle Ages Rouffach became a famous place

of pilgrimage for epileptics. A hospital was built which accommodated ill pilgrims.

A woodcut from the time (Fig. 2) represents St Valentine blessing devotees, two of

whom are lying on the ground. A pig near St Valentine probably represents the devil

whom the saint has exorcized. The German legend says Sankt valentin bit got ftlr uns

zu rufach (St Valentine, pray to God on our behalf at Rouffach).

Saint John also used to be invoked against the disease, which was often called ma1

St Jean in French and St Janseuvel or St Jansplaag in Dutch. It is not clear whether

the patron was St John the Baptist or St John the Evangelist, nor why precisely he was

invoked against epilepsy.

In Germanic countries, yet another saint used to be called upon to assist in case of

epilepsy or to protect one from the disease: St Cornelius. In Belgium, until recently,

children were often given four names at birth. The first name was the one to be


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364

Journal

of Neurolinguistics,

Volume 6,

Number 4 1991)

Figure 1.

normally used to call the child. The second and third names were generally the first

names of the childs godfather and godmother, or the childs grandfathers or grand-

mothers. Not infrequently the fourth name was Cornelius (or its feminine form

Comelia) in the northern (i.e. Dutch-speaking) part of Belgium. By giving their child

the name of the saint, parents sought to protect it from epilepsy.

Sudden falls were considered the hallmark of epilepsy. Accordingly, the disease was

called falling sickness, falling ill or falling evil. The Romans used morbus caducus,

the French ma1 caduc, the Italians ma1 caduco, the Dutch vallende ziekte, vallend

euvel, vallende krankte of vallende zucht, and the Germans die Fallsucht, die fallende

Sucht, das fallende Lcid, die fallende Krankheit, or simply das Fallende. In old

French, the condition was defined as le ma1 de quoi lon chiet (= the disease that

causes you to fall).

In French, epilepsy was also called mal de terre, i.e. ground or earth disease, maybe

because the sufferers fall to the ground.

Convulsions are another striking feature of epilepsy. Hence the name cramp was


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Figure 2.

sometimes used in England to denote the condition. A cramp-ring was a ring assumed

to be efficacious against cramp, i.e. falling sickness, especially if it had been hallowed

by the king on Good Friday.

In slang cramp was called crank. A counterfeit crank was a rogue who feigned

epilepsy in order to move compassion or get money.

As for the word epilepsy itself, it is derived from the Greek verb epilambanein,

which means to take hold of, to seize. The image survives in the English word seizure.

Apparently the word Cpilepsie was introduced by the French physician Ambroise Pare

in the 16th century.

An epileptic seizure or attack may also be called an ictus. The word originally meant

a blow, a stroke. The derived adjectives ictal, post-ictal and interictal are often used

to refer to behaviours during, after or between seizures.

The word aura, which is akin to the word air, means breeze, zephir. It is used to


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1991)

refer to the premonitory symptom(s) of a seizure, because the Greek physician Galen

(130-200 A.D.) once heard an epileptic boy liken the sensation which he felt just

before an attack to a cold breeze blowing upon a part of his body. The word aura

nowadays denotes any sensation which the patient perceives just prior to an attack and

which he recognizes as a forerunner of the seizure.

A number of celebrities were, or are reported to have been, epileptic. The list

includes Hercules (hence the name ma1 herculeen which was sometimes used in

French to refer to epilepsy), Socrates, Julius Caesar, Mohammed, Napoleon, Gustave

Flaubert, Dostoiewsky and Vincent Van Gogh. The French epileptologist Gastaut

(1956, 1979, 1982) has devoted several studies to the epilepsy of the last three ones.

Though considered a dreadful malady, epilepsy was thought to protect its victims

from schizophrenia or madness. This erroneous view prompted the first attempts with

electroshocks to improve severe mental disorders. Though they do not render the

patients epileptic, electroshocks have proved useful in the treatment of some psychiatric

conditions.

From the medical point of view, epilepsy is a neurological condition characterized

by abnormal firing of cerebral neurones. The clinical manifestations vary according

to the place in the brain where the abnormal discharge occurs and the number of

neurones involved. On the basis of its observable symptoms epilepsy is usually divided

into major and minor epilepsy.

TYPOLOGY OF EPILEPSY

Major Epilepsy also called grand ma1 epilepsy)

Major tits are characterized by a loss of consciousness. The patient falls to the

ground. At first, there usually is a phase of tonic spasm affecting both sides of the

body in a rather symmetrical way. During this tonic phase, which is of short duration,

respiration is arrested due to the spasm of the respiratory muscles. Prior to the apnea

the patient may let out a yell, the so-called initial epileptic cry.

After a short while, the sustained tonic muscular contraction gives way to sharp

successive jerks. In this clonic phase, the tongue may be bitten, and foaming at the

mouth may occur. Incontinence of urine is frequent. Respiration is re-established but

may be stertorous.

Towards the end of the clonic phase the intervals between the muscular contractions

become longer and the jerks finally cease. The patient remains unconscious for a

variable period of time and on recovering consciousness, he may feel tired or stiff all

over. There may be temporary dizziness. There may also be a transient motor deficit

called Todds paralysis. Not infrequently the patient sleeps for several hours after the

attack.


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Language and Epilepsy

367

In a number of cases, the seizure itself is preceded by an aura, or warning of the

attack. It is a symptom produced by the beginning of the pathological discharge and

perceived by the patient before consciousness is lost. The aura may take the form of

a complex mental state, such as a feeling of unreality (a sense of jamais vu) or,

on the contrary, of familiarity (a sense of deja vu), as if events being experienced

have happened before. The patient may feel that he is disembodied, or he may be

seized by intense fear. The aura may also take the form of hallucinations or of unusual

bodily sensations. Sometimes the fit is introduced by a spasm or a clonic movement

of some body part.

Minor Epilepsy

In minor epilepsy the symptomatology is less dramatic than during grand ma1

seizures. It may take various forms. The most frequent of them are:

Petit Ma1

Petit ma1 episodes are transient absences, i.e. blank spells, during which the patient

stares into space and stops whatever he is doing. He is unresponsive to the outside

world. After the attack, which is of short duration, the activity is resumed, the patient

being often unaware that a fit has taken place.

Akinetic Epilepsy

This form of minor epilepsy is characterized by a disturbance of consciousness

accompanied by a fall. The convulsive movements of grand ma1 epilepsy are not

observed.

Temporal Lobe Epilepsy

In temporal lobe epilepsy the patient usually has hallucinations. He may hear sounds

or noises (= acousmas) or words, or he may see shapes or scenes, or else objects may

look abnormally small (= micropsia) or unusually large (= macropsia). Moreover, he

may carry out a number of actions without being aware of it. These actions are called

automatisms and may or may not be appropriate. When the patient performs repeti-

tive, aimless movements, the seizure is said to be psychomotor. The automatic activity

may evolve into a raptus or paroxysm of compulsive and at times violent behaviour.

Such attacks are often called complex partial seizures. They are associated with a

clouding of consciousness and afterwards the patient shows complete or partial loss

of memory of what happened during the seizure.

Jacksonian Epilepsy

Jacksonian seizures usually begin with clonic movements in a limited part of one


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J ournal of Neurolinguistics, Volume 6, Number 4 1991)

side of the body. The starting point is often the thumb or index finger, the corner of

the mouth or the great toe. From there the convulsion may spread and eventually

involve the whole half of the body.

At times, involuntary muscle contractions cause the head and eyes to turn to one

side. Such fits are called adversive. In some instances, the turning of the head is

followed by a gyration of the whole body resulting in a fall.

Sensory Epilepsy

This form of epilepsy is the sensory equivalent of motor Jacksonian epilepsy and

consists of parasthesias involving part or whole of one side of the body.

Myoclonic Epilepsy

In myoclonic epilepsy there is clonic contraction of a muscle, or of symmetrical

muscles on opposite sides of the body. In some cases the contraction is too slight to

cause any perceptible movement. In other cases, myoclonias are so violent that they

can throw the patient off his feet.

Jacksonian, sensory and myoclonic attacks are sometimes called partial seizures

because they involve a limited part of the body.

Minor epileptic fits not infrequently evolve into major (generalized) attacks, or

alternate with them.

Reflex Epilepsy

If epileptic fits are regularly triggered off by a specific and identifiable stimulus,

the patient is said to have reflex epilepsy. In reflex epilepsy the precipitant stimulus

may be a sensation more or less passively received by the individual, or an action

performed by him.

Clinical Versus Sub-Clinical Epilepsy

Attacks which can be perceived by an external observer are called clinical. When

the epileptical discharge is recorded electroencephalographically but fails to produce

perceptible symptoms, the fit is said to remain sub-clinical.

Status Epilepticus

A patient is considered to have status epilepticus when attacks follow one another

in quick succession without intervening period of full consciousness.


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Convulsions

The involuntary violent muscle contractions that are observed during some epileptic

fits are usually referred to as convulsions.

Electroencephalography

Electroencephalography is a technique by means of which the bioelectrical activity

of the brain can be recorded using scalp or implanted electrodes.

Resting electroencephalograms of epileptics may be devoid of anomalies. There-

fore, such provocative manoeuvres as (drug-induced) sleep, hyperventilation, or

photic stimulation are often used to elicit electric signs testifying to the existence of

an ictal disorder.

Aetiology

Epilepsy may have many different aetiologies ranging from processes entailing

intracranial pressure (e.g. cerebral tumours) through cerebral traumas to inflam-

matory, degenerative, circulatory or metabolic affections of the central nervous system.

Sometimes no local or general cause can be found for the observed convulsions. The

epilepsy is then said to be constitutional, idiopathic, essential or primary.

LANGUAGE AND EPILEPSY

The relationships between language and epilepsy are both complex and reciprocal.

On the one hand, verbal activities may provoke abnormal bioelectrical discharges in

the brain. Not infrequently, these paroxysmal bursts are accompanied by clinical signs

such as involuntary muscle contractions or absences which interfere with language

production. Indeed, at times complete speech arrests are observed. There may also be

impaired comprehension.

On the other hand, epileptic seizures not engendered by verbal activities may bring

on unintentional verbal behaviours, such as involuntary repetitions of words or

utterances. Or they may cause the patient to use jargon. Also, following ictal episodes,

verbal skills may be temporarily impaired.

In addition, chronic epileptics may evidence linguistic deficits that seem to be due

to their brain pathology, or to the medications they have been using, or to a combina-

tion of both.

There also exists a pediatric disease, the Landau-Kleffner syndrome, whose main

features are epilepsy and aphasia. Whether these two symptoms are simply con-

comitants or are causally related is still a matter of debate.


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370 Journal of Neurolinguistics, Volume 6, Number 4 1991)

In some cases of stuttering, too, there appears to be a link between the speech

impediment and paroxysmal brain activity.

The papers in the present volume illustrate or discuss some of the relations which

exist between language and epilepsy.

NOTES

Address correspondence to: Prof. Dr Y. Lebrun, Neurolinguistics Department,

School of Medicine V.U.B., 103 Laarbeeklaan, 1090 Brussels, Belgium.

REFERENCES

Gastaut, H.

1956

La maladie de Vincent Vun Gogh envisagke ci la lumi -e des conceptions

nouvelles sur 1kpilepsie psychomotrice, Cahors: Coueslant.

1979

Linvolontaire contribution de Fiodor MikhaIlovitsch Dostoievski a la

symptomatologie et au pronostic de lepilepsie, LEvolution Psychiutrique

44. 215-47.

Gastaut, H. and Y. Gastaut

1982

La

maladie de Gustave Flaubert,

Revue Neurologique 138. 467-92.

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