Absence status epilepticus: The first documented case?

Abstract

Even the oldest texts on epilepsy indicate awareness of seizures occurring in series. In the story of the epileptic boy in the Gospel of St. Mark, Jesus returns to his disciples from a short period away and finds them dealing with an epileptic boy whom they could not help. This implies the occurrence of repetitive seizures. Two more seizures at short interval follow in the presence of Jesus who then successfully expels the disease demon. It is unknown, however, to what extent this description of a status epilepticus (SE) is based upon real events. The first historical case of SE seems to be documented on an ex-voto table of 1501 in the parish church of Gmund in Austria (Fig. 1). The neatly written text says: “Oswalt . . . ain purg–zu gmund ist vor vi jar–n zu–alt–noting gbes–n mit seine–sun der hinfalt–n siechtu–het ain wenich gepessert & hat ersup im fur gnome–nymer gen alt–n oting kume–. Nun in der woche– nach oculi im 1501 Jar in grosse kranckhait gfalle–das er gleg–n ist mit offen augen unrednt pis an de–dritte–tag und vil volk zu im gangen. Niemant erkent noch gsehe–und seines leben gar verzigen hab–n also hat in sein hausfrw her versprochen mit aine–priester und mit aine–waxen hawbt und ist gesund worden, sag er lob und danck der Junckfraw mari–in ebikait. Und ist hie gebest am suntag vor dem auffertag Im 1501 Jar. & [signature]” (“Oswalt . . ., a citizen of Gmund, went 6 years ago to the old Otting with his son who has the falling sickness, was little improved and he resolved never again to take to old Otting. Now, in the week after Oculi in the year 1501, fell into great illness that he lay with open eyes speechless until the third day and many people came to him, did not recognize or see anybody, and they lost all hope for his life. So his wife engaged him here with a priest and a waxen head, and he recovered. Say honour, praise and thanks to the Virgin Mary in eternity. And this happened here on the Sunday before Ascension Day in the year 1501”. – Altotting or “the old Otting” is to this day a very popular pilgrimage in Bavaria). The painting appears to be the work of a local artist who may well have seen the patient in the acute phase. It shows