The clinical applications of EEG: origins.

The first paper in our series Classics in Epilepsy and Behavior is ‘‘Epilepsy: A Paroxysmal Cerebral Dysrhythmia,’’ published in Brain by Gibbs, Gibbs, and Lennox in 1937. The paper serves as a landmark for spurring interest in the role of EEG in clinical epilepsy as well as linking the term ‘‘psychomotor epilepsy’’ to a specific EEG pattern. The application of EEG technology to human seizure disorders was slow. Richard Caton (1842–1926), a British physician, published his findings of the electrical phenomena of the exposed cerebral hemispheres of rabbits and monkeys in 1875. According to Brazier, the discovery of the EEG went unnoticed by clinicians in Western Europe and America for nearly 60 years [1]. However, work proceeded in Eastern Europe with the ‘‘rediscovery’’ of EEG by Adolf Beck (1863–1942) in Krakow, Poland, in 1891 and the tests of whether an epileptic attack might be accompanied by abnormal EEG activity in dogs by Pavel Yurevich Kaufman (1877–1951) in St. Petersburg in 1912. Gibbs, Gibbs, and Lennox thank ‘‘the pioneer work of Berger’’ in developing the EEG [2]. Indeed, Hans Berger (1873–1941), a German neuropsychiatrist, began study of the human EEG in 1924 in patients with large skull defects (post-World War I injuries), but soon recognized that readings could be made just as well through an intact skull and scalp [3]. A complex character, Berger worked in isolation with incredibly primitive equipment. The first report of 1929 recorded from the head of Berger s son featured the alpha rhythm and the alpha blocking response [4]. Berger s findings were greeted with universal skepticism, but they were eventually confirmed in 1934 by Adrian and Matthews in England [5]. While documenting the first recordings of the EEG in epilepsy, Berger failed to recognize the clinical significance of EEG to seizure disorders. Brazier explains this oversight as counter to Berger s conception of EEG as a means to study the nature of mental energy (‘‘psychische Energie’’) [1]. More a ‘‘psychophysiologist’’ than a neurophysiologist, Berger sought the correlate of mental energy in EEG. Formidable technological gaps contributed to the slow incorporation of EEG to human seizure disorders; however, conceptual gaps regarding the nature and interpretation of brain waves remained even more significant obstacles. America played no role in the early development of experimental EEG [3]. Instead, a small group of American neurophysiologists of the late 1920s deemed themselves ‘‘axonologists’’ and focused their efforts on separating the components of conducted action potentials in somatic and autonomic nerves [6]. As Gibbs recalled in an interview, ‘‘the axonologists whittled the nervous system down to one axon and knocked themselves out studying that. They told me that studying the whole brain (i.e., EEG) was just ridiculous’’ [7]. Hallowell Davis (1896–1992) and colleagues at Harvard Medical School confirmed Berger s alpha rhythm in late 1934 [8]. This demonstration lured Frederic and Erna Gibbs to join forces with him and try the ‘‘brainwave’’ equipment as a potential means of studying epilepsy [8]. Frederic Gibbs (1903–1992) had come from Johns Hopkins University to work with William G. Lennox (1884–1960), already a well-known epileptologist, at Boston City Hospital. Lennox and Gibbs had been frustrated in their work on a circulatory hypothesis of seizures. They demonstrated no cerebral anoxia with seizures; however, their techniques remain pioneer work in cerebral blood flow studies [3]. Erna L. Gibbs, an immigrant from Germany, was originally a technical coworker of Lennox, married Frederic Gibbs, and was one of the world s first EEG technicians and co-author of many papers and texts. Epilepsy & Behavior 3 (2002) 393–394