J.S. van der Kolk's influence on American concepts of epilepsy

E.J. Fine and D. Fine*
Neurology Service, Dept. of Veterans' Affairs, Buffalo, and *Dept. of Neurology, State University of New York at Buffalo, USA

Objective. To demonstrate Jacobus Schroeder van der Kolk's (JSvK) influence on American concepts of pathophysiology of epilepsy.

Background. JSvK (1797-1862) performed autopsies and microscopic examination of brains of epileptics. JSvk summarized his theories in the Sydenham Lecture of 1859, On the minute structure and functions of the medulla oblongata and the proximate causes and rational treatment of epilepsy. Pioneer American neurologists, William Hammond (WH) cited JSvK in A treatise on the diseases of the nervous system (1871) and Manuel Gonzalez Escheverria (MGE) in On epilepsy (1870).

Method. Review American neurology textbooks from 1870-1880 for theories to pathology of epilepsy.

Results. JSvK found that veins draining cortex, medulla oblongata and spinal cord of epileptics were dilated and congested with blood. Microscopic examination of medulla oblongata showed "fatty degeneration with albuminous intracellular fluid". Blood vessels supplying hypoglossal nucleus were dilated in patients who bit their tongues in seizures. Those not biting their tongues had dilated vessels supplying the vagal nucleus. JSvK concluded "that the first cause of epilepsy ... is exalted sensibility and excitability of the medulla oblongata", renders it "liable to discharge upon itself" and these discharges caused spasms in blood vessels leading to hyperemia followed by "involuntary reflex movements...". Repeated seizures caused inflammation in cerebral cortex leading to "incurable dementia" due to "thickening and dilatation of blood vessels". WH lauded JSvK with "no one has been more thorough in the search for the essential cause of epilepsy than he". WH presented clinical cases affirming "seat of seizures ... was mainly in medulla oblongata". MGE described and illustrated autopsies of patients dieing after seizures. Despite finding cortical infarcts, hemorrhages and syphilitic gumma, MGE stated these lesions "excited medulla oblongata" which induced seizures. By reviewing David Ferrier's experiments mapping motor cortex of subhuman primates and Victor Horsley's observations from faradic stimulation of human cerebral cortex during surgery for ablating foci of motor seizures, we will explain why JSvK's theories were supplanted by current concepts of cortical origin of focal motor seizures.

Conclusions. During 1870-1880, the writings of JSvK influenced American concepts of epilepsy.

Session III
Friday, 20 June 1997, 14.35 - 14.55

Second Annual Meeting of the International Society for the History of the Neurosciences (ISHN) and 6th Meeting of the European Club on the History of Neurology (ECHN)

Leiden, The Netherlands