Epilepsy at the millennium

Thus Chaucer, writing a third of the way into the second millennium but looking back into the past and reflecting on how language changes. Today, seven hundred years on, we look back on Chaucer’s English and, without help, few of us can fully understand it: look back another three hundred years to the start of the second millennium and we hardly understand the thoughts and customs of our ancestors let alone their language. Did they ever wonder what life would be like a thousand years on, at their millennium? Did they expect unremitting change and progress as we do? The evidence that we have suggests that there was only a little millennium angst a thousand years ago (mostly among the clergy) and that it was assumed that there would be little change in the future (and yet, within seventy years, life for our Saxon ancestors changed forever). ‘The Millennium’ did not have the significance it does now and celebrating it as we do would have seemed a little bizarre. Will our descendants look back on us, at the start of the fourth millennium and wonder at us? Will they be speaking the same language—or, at least, still understand ours? How will they view our scientific and medical discoveries, of which we are so proud and confident? Mankind enters the third millennium with the developing ability to change the genetic structure of plants, animals and itself and is beginning to fully comprehend and be able to manipulate the functions of the brain. Will our ancestors (assuming we have them! ) be celebrating that in a thousand years? Will historians, in a thousand years, be poring over this journal wondering at our quaint language and at our ignorance? Will war and pestilence have swept away civilization (as it nearly did in Chaucer’s England)? The questions are endless, the answers few and speculation perhaps sterile. But the millennial transition is perhaps the time to reflect on the past, assess the present and peer hopefully into the future of epilepsy. Over the next year or so we will be publishing in ‘Seizure’ various contributions from the Millennial Conference of the British Branch of the International League Against Epilepsy, reflecting on the history of epilepsy, on our present practices and on what we feel the growing points of epilepsy will be. Perhaps in one hundred years time and just possibly in a thousand, these issues of Seizure will be taken off a dusty shelf and some academic, hungry for material for a thesis (will there still be theses in an hundred or a thousand years time? ) will try to determine how we felt about epilepsy at the turn of the century, how we managed it and how it was conceptualized. He or she may be surprised: as surprised as I was when I conducted a similar exercise a few years ago and reviewed the UK psychiatric literature on epilepsy of one hundred years ago. I had assumed that it would probably be negative—how could authors be positive about a condition like epilepsy when the only available drug was sodium bromide: but what I learnt was that the view of epilepsy held by practitioners at the time was very positive. ‘Epilepsy wards’ might be turbulent places with frequent fights, multiple seizures and rich psychopathology but the authors were enthusiastic about improving Quality of Life (and were well-aware of its issues and dimensions) and recognized the importance of social and psychological treatment—they also fully recognized the limitations of drug treatment and the importance of distinguishing drug side effects from the effects of epilepsy itself. So, it is useful to reflect upon where we have come from in terms of our medical thinking and practice (and to pay due acknowledgement to the past) and also to try to illustrate, both for ourselves and our descendants, what our current concept and practice of epilepsy is. These millennial contributions will include historical essays, including a fascinating paper on Anglo-Saxon medicine, and papers outlining current knowledge and a little speculation about the future. But we are going to start with the patient himself and herself: what are our patients’ experiences as we turn the corner of the Millennium? How do we,