The Assyrians & Epilepsy

The first evidence of epilepsy’s description is interwoven with the advent of human civilization, a condition known as “antasubbu” that plagued the unfortunate in early Mesopotamian (Akkadian, including both Assyrian and Babylonian) society nearly 4,000 years ago.¹ The word, antasubbu, translates to “falling sickness,” a quite literal description of the disease. At times, this term was interchangeable to what the Assyrians would refer to as “qāt Šîn,” the hand of Sin. This description was a nod to its assumed etiology, an illness brought about by the god of the moon known as Sin or Nanna. There was some attempt to link the frequency of falling episodes with the moon cycles, which today would be of interest if what they were truly observing was actually catamenial epilepsy, seizures that wax and wane with the female menstrual cycle. Widely quoted, the description of antasubbu was familiar to our own descriptions today, “his neck turning left, hands and feet are tense, and his eyes wide open, and from his mouth froth is flowing without him having any consciousness.”

The Babylonians followed nearly 1,000 years later, writing one of world’s earliest medical diagnostic manual, known as “Sakikku” or all diseases.⁶ The manual included descriptions of different types of seizures, such as miqtu/bennu (fall), hayyatu (fit), and sibtu (seizure).² The word bennu, which was usually interchangeable with miqtu, was in reference to the demon that Babylonians thought caused the falling sickness. When describing seizures or sibtu, the phrases “sibit etemmi” and “qiit etemmi” (seizure by a ghost and hand of a ghost respectively), are used throughout the tablet. For example, “if his seizure (or, possession) always takes place in the evening, it is the seizure of a ghost.”²  The ghosts were separate from demons and would only appear at night, almost as if nocturnal epilepsy was being described with ghosts, while miqtu/bennu was in reference to diurnal epilepsy attributed to demons. The passages on diurnal epilepsy commonly cited midday as the most likely time for people with epilepsy to experience an attack.² Additionally, there are descriptions of febrile seizures, focal seizures, generalized seizures, the gelastic seizures, status epilepticus, and postictal state.^3,4

The depth of detail in the descriptions of seizure types are what make tablet 26 feel so precocious for its time. There are “two symptom entries” that describe the auras associated with temporal lobe epilepsy with formidable accuracy. For example, “If ditto, he has a feeling of distention in his epigastrium and “his legs are lifted up” (i.e., he sits motionless(?)),-seizure by a ghost.”² Rising epigastric sensation is a well described aura seen in those with an epileptic focus arising from the mesial temporal lobe. Similarly, “If ditto, his eyes become cloudy and his ears hiss,-seizure by a ghost,”² the hiss in this description could also be described as a ringing, buzzing, or machine-like whirring, commonly seen in foci involving the superior temporal gyrus or auditory cortex.

There are passages that also describe automatisms and rare forms of epilepsy. “If the possessing demon has been possessing him again and again, and as a result of his possessions he is constantly wiping clean his hands and face, the ghost of a person who died in water has possessed him. At midday it will be most serious for him. R: A demon from the river has smitten him.”² The imagery of the person wiping his hands/face can be similar to the repetitive disinhibition seen in different automatisms. It is also interesting that this passage attributes the behavior to a different demon (one prevailing from a drowned man) rather than the classic bennu, seen more when the person has fallen. Another line states, “[If at the] time of his epilepsy he laughs loudly for a long time, his legs-R: “his hands and legs”-being continuously flexed and extended,-hand of Lilu.” The imagery of laughter in combination with jerking movements reminds one of gelastic epilepsy. Of note, Lilu was a god/demon whose punishments more commonly targeted that of young children with night terrors; parents would commonly pray to other gods to protect their children from Lilu.² While gelastic epilepsy is rare in general, it tends to afflict children more than adults since it commonly arises from hypothalamic hamartomas that develop as part of congenital neurocutaneous disease, tuberous sclerosis complex.⁵ The incorporation of Lilu could represent the Babylonian’s primitive understanding of who was more likely to suffer from this seizure type.

Finally, the description of generalized tonic-clonic seizures, “If at the end of his fit his limbs become paralyzed, (the demon) “pouring out” upon him so much that he loses control (of his functions); if when he thus “pours out” upon him his eyes are red and his face expressionless; if his ser’anu-vessels (mod.: “arteries”) pulsate at a quickened rate and he cries although the tips of his fingers and toes remain cold; if when the exorcist asks the sick person to repeat (a prayer) he repeats what he says to him, but after (the demon) has let him go he does not know what he said,-hand of Lila-la’bi.”² This description touches multiple tenants of generalized epilepsy. Firstly, this section describes a person who is not in control, or perhaps unconscious. There is increased sympathetic activity with a quickened pulse, or a seizure induced tachyarrhythmia. The sufferer will nonsensically repeat prayers said to him but have no recollection of those verbalizations which could represent hyperreligiosity rarely seen in temporal lobe epilepsy. Lastly, the sufferer has no memory of this event: post-ictal amnesia. The confusion defining a post-ictal state, or even post-ictal psychosis is described in the following passage: “If when his limbs become at rest again like those of a healthy person he blinks and begins to regain consciousness, and when you try to speak with him he acts strangely (or, like a strange person),-hand of Lilu (or) of a messenger of his god.”²

There were even legal ramifications described for people with epilepsy in Babylonia. In the Hammurabi Code (1790 B.C.) it was written that slaves afflicted with bennu² within a month of purchase could be returned and money used to purchase them refunded.⁶ Clearly, slaves with epilepsy were seen as defective property, and the disability would be difficult to pass unnoticed.

In examining the extensive descriptions of epilepsy in ancient Assyria, it is evident that Mesopotamians had a complex yet detailed understanding of this neurological disorder. Texts from both the Akkadian and Babylonian periods offer vivid portrayals of different seizure types, symptoms, and ramifications. Even without modern medical knowledge, these ancient societies recognized the varied nature of epilepsy and attributed it to supernatural forces, reflecting an early attempt to categorize and make sense of human illness. By tracing these early descriptions and interpretations, we gain insight into the evolution of medical understanding and the ways epilepsy has been perceived and treated across history. This legacy underscores how deeply intertwined epilepsy is with the development of human civilization, inspiring us to consider both the advancements we have achieved and the challenges that remain in understanding and destigmatizing this condition.

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[1] Labat R: Traité Akkadien de Diagnostics et Pronostics Médicaux . Académie internationale d’histoire de

sciences, Paris, France; 1951.

[2] Wilson JK, Reynolds EH. Translation and analysis of a cuneiform text forming part of a Babylonian treatise on epilepsy. Medical history. 1990 Apr;34(2):185-98.

[3] Eadie MJ, Bladin BF. A disease once called sacred: a history of the medical understanding of epilepsy. Eastleigh: John Libbey; 2001. p. 17–20

[4] Scurlock J, Andersen BR. Diagnoses in Assyrian and Babylonian medicine. Chicago: Univ. of Illinois Press; 2005. p. 315–23.

[5] Téllez-Zenteno JF, Serrano-Almeida C, Moien-Afshari F. Gelastic seizures associated with hypothalamic hamartomas. An update in the clinical presentation, diagnosis and treatment. Neuropsychiatric Disease and Treatment. 2008 Dec 1;4(6):1021-31.

[6] Stol M. Epilepsy in Babylonia. Amsterdam: Brill; 1993. p. 5–7.

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