Update

Letters

Was Julius Caesar's epilepsy due to neurocysticercosis?

Taeniasis, the intestinal infection caused by Taenia solium, T. saginata and T. asiaticus, involves a fecal-oral route of transmission between humans (definitive hosts) and the intermediate hosts, pigs for T. solium and T. asiaticus, and cattle for T. saginata. Meat and viscera of infected animals, not excluded from the food chain, are the source of human infection. Therefore, countries with poor sanitary conditions and meat inspections are among the most affected. T. solium deserves special attention since it can also cause human neurocysticercosis, the perilous presence of the larval stage in the central nervous system. Control strategies to combat these zoonotic parasites should be based on a combined approach including treatment, vaccination, health education, and improvements in sanitation, pig husbandry and meat inspection.

Since it was first described in a Mesopotamian text in 2000 bc, countless individuals have offered their perspectives on epilepsy's cause, treatment, and even deeper spiritual significance. However, despite the attention the disease has received through the millennia, it has only been within the past half-century that truly effective treatment options have been available. As a result, for the vast majority of recorded history, individuals with epilepsy have not only had to deal with the uncertainty of their next epileptic seizure but also the concomitant stigma and ostracization. Interestingly, these individuals have included several prominent historical figures, including Julius Caesar, Vladimir Lenin, and Fyodor Dostoyevsky. The fact that epilepsy has appeared in the lives of influential historical people means that the disease has played some role in affecting the progress of human civilization. Epilepsy has cut short the lives of key political leaders, affected the output of talented cultural icons, and, especially within the past half century, influenced the collective understanding of neuroscience and the human nervous system. In this article, the authors review how epilepsy throughout history has manifested itself in the lives of prominent figures and how the disease has helped shape the course of humanity's political, cultural, and scientific evolution.

Human taeniasis as well as porcine and human cysticercosis — caused by the pork tapeworm Taenia solium — are ancient diseases. The fact that pigs were considered impure in the ancient Greece and that the Koran prohibited the consumption of pork, were likely related to the knowledge that cysticercosis may affect swine. Evidence suggests that human cysticercosis was also present in the ancient Egypt and Rome. During the Renaissance, the causative agent was properly identified and human cases were recognized. Confirmation that both taeniasis and cysticercosis were caused by the same parasite was provided during the 19th Century by German pathologists. During the 20th Century, bouts of human cysticercosis in non-endemic regions left us valuable lessons on the mechanisms of disease acquisition and spread. These included a large series of neurocysticercosis cases in the United Kingdom that occurred after the return of troops stationed in India (which demonstrated that symptoms may occur years after infection), the epidemic of cysticercosis-related epilepsy in the Ekari people of Papua New Guinea occurring after the gift of pigs with cysticercosis received from Indonesia (demonstrating the fast establishment of endemic transmission and the impact of cysticercosis in epilepsy frequency), and the occurrence of neurocysticercosis among members of an Orthodox Jewish community of New York City, related to Latin American Taenia carriers working in their houses (highlighting the fact that cysticercosis transmission do not require the presence of infected pigs). These lessons of history have significantly contributed to our current knowledge on this disease.

Julius Caesar (100–44 BC) was one of the most charismatic political figures in history. Best remembered for his military achievements, he was also a writer, historian, and statesman. Through his constitutional reforms, he played an important role in the events that led to the end of the Roman Republic and the birth of the Roman Empire. Historical sources reveal that Julius Caesar suffered from headaches, seizures, and personality changes. In this essay, we highlight the life of Julius Caesar, with emphasis on the potential origin of his sickness. Although a definitive diagnosis obviously cannot be made, as new published studies showed a possible cerebrovascular etiology, a new hypothetical diagnosis is presented.