The ligature in the management of epilepsy.
For some 1700 years, from the time of Galen and Arateus, the application of a ligature to a limb proximal to the site of the commencement of the aura of an epileptic seizure was employed to arrest the further development of that seizure. The method disappeared only in the past century. In ancient times the ligature was thought to prevent the cause of the seizure from ascending the vessels of the affected limb and ultimately reaching the head. Thomas Willis (1621-1675) believed the ligature prevented further neural energy supplies from the central nervous system reaching the peripheral site at which the epileptic event had begun, so that the local explosive process causing the seizure could not be maintained, let alone extend centrally. Brown-Séquard (1817-1894) considered that the ligature blocked the increased afferent nerve traffic from the affected site which he postulated was the cause of epileptic seizures. By the latter part of the 19th Century, William Gowers (1845-1915) had realised that the ligature must exert its effects in the brain, by setting up an afferent input from the periphery which at cerebral level increased inhibition in and around the cortical area involved in the spreading epileptic discharge.
Eadi
M J
MJ
Department of Medicine, The University of Queensland, Royal Brisbane Hospital, Herston, 4029 Australia.