Professor Shorvon’s treatise on “the why” and “the what” of epilepsy is structured in three main sections – an introduction and prologue, a chronological history of epilepsy, and an epilogue with appendices, bibliography, glossary and index. He chronicles the modern era of epilepsy through the perspectives of science, medicine, society and the individual’s experience of having epilepsy. The meaty mid-section comprises of five chapters, each focusing on a particular epoch (1860-1914, 1914-1945, 1945-1970, 1970-1995 and 1995-2020). In meticulous detail and rich language, Shorvon traces the seismic shifts in the conceptualisation of epilepsy and how those with the condition have been regarded in the past 160 years. He draws from an extensive bibliography, invoking Oswei Temkin, Blaise Pascal, Nikolaus Pevsner, George Orwell and Sherlock Holmes within the space of the first three pages. David Cobley’s accompanying illustrations accentuate the bleakest facets of epilepsy and at times evoke visceral discomfort. Most in the neurology community are aware of superstition-laced historical views of epilepsy and the appalling stigmatisation of the condition. Even so, it is jolting to read here of contagion, criminality, eugenics, institutionalisation, epilepsy colonies, marriage prohibition, sterilisation and euthanasia.
Shorvon summarises the radical advances in science and medicine that have enabled epilepsy to become better understood and managed, while highlighting some tragic mistakes and harms along the way. He details the evolution of epilepsy surgery and the development of anti-seizure medications and their use. He delves into the iterations of epilepsy classification and terminology, the realisation that there is not a simple mechanism to explain most cases of epilepsy, and the conceit of epilepsy as a network disorder. He takes stock of which developments have endured and which might yet disappear. There is a vast amount of material presented, such as the first advertisement for phenytoin, an explanation of the quirky numbering system employed by Epilepsia, and the nugget that lamotrigine was initially developed on the erroneous assumption that it had anti-folate activity.
Notwithstanding the comprehensive glossary, some sections may not be readily accessible to lay readers. At times the text becomes saturated in minutiae and the narrative flow slows. The conscious omission of the achievements of living people is, in part, understandable although results in some conspicuous gaps. The author’s passion for and knowledge of the field is evident throughout. Overall, this is an engaging history of epilepsy – an entity that is complex and fascinating but which Shorvon suggests might not even exist…
