Some of the oldest surviving written descriptions of seizures come from ancient Mesopotamia, thousands of years before EEG, neurology or even a scientific understanding of the brain existed.
These records are important for two different reasons. First, they show that ancient observers could describe seizure phenomena with remarkable clinical precision. Second, they show just how differently those observations were interpreted. The physical event could be recorded accurately while its cause was explained through demons, spirits, gods and supernatural possession.
That combination — careful observation alongside a completely different theory of disease — makes Mesopotamian epilepsy texts one of the most revealing starting points in the history of neurology.
Where was ancient Mesopotamia?
Mesopotamia was the region between and around the Tigris and Euphrates rivers, largely corresponding to modern Iraq and parts of neighbouring countries. Over several millennia it was home to Sumerian, Akkadian, Babylonian and Assyrian cultures.
Medical knowledge was written in cuneiform script on clay tablets. Because baked and dried clay can survive for extraordinary lengths of time, thousands of tablets have reached the modern era, including medical texts dealing with diagnosis, prognosis, remedies, ritual practice and descriptions of illness.
The surviving evidence is fragmentary. What exists today is not a complete medical library from one moment in history. Texts were copied, revised and transmitted across generations, and many tablets survive only in pieces. Historians therefore have to reconstruct ancient medical traditions from material written at different places and times.
An older seizure description predates Sakikkū
Modern historical reviews often begin with an Akkadian text dating to around the second millennium BCE. It describes an episode in which a person’s neck turns, the limbs become tense, the eyes open widely, froth appears at the mouth and consciousness is lost.
To a modern reader, that description is immediately recognisable as a severe convulsive seizure. But it would be misleading to retroactively diagnose an exact modern seizure type from a short ancient text. We do not have the patient, the full clinical context or modern investigations.
What the passage does demonstrate is that people in Mesopotamia were observing and recording recognisable seizure phenomena long before the classical Greek medical tradition.
What was Sakikkū?
The most important surviving Mesopotamian diagnostic collection is usually referred to as Sakikkū. The Akkadian title is translated in different ways in modern scholarship, including Symptoms and, in older epilepsy literature, All Diseases.
The diagnostic series comprised around forty tablets and thousands of entries. It was not a modern textbook organised around anatomy and physiology. Instead, it collected observed signs, interpretations and prognostic statements: if a patient showed a particular combination of features, the text associated those features with a particular cause or predicted outcome.
The series was compiled in the form known to us during the late second millennium BCE, commonly associated with the scholar Esagil-kīn-apli in the eleventh century BCE, although it drew upon older Mesopotamian medical traditions.
The epilepsy tablet
Tablet XXV/XXVI of the diagnostic series contains the best-known ancient Babylonian material dealing with epilepsy. Historians J. V. Kinnier Wilson and E. H. Reynolds published an influential translation and analysis of this text in 1990.
The tablet contains descriptions of repeated falls, convulsive attacks, loss of awareness, asymmetric motor phenomena and behavioural changes. It also records features occurring before and after attacks and comments on prognosis.
For that reason, scholars frequently describe it as the oldest surviving detailed written account devoted specifically to epilepsy as it was understood in its own culture.
What did the Babylonians actually observe?
The striking feature of the text is not simply that seizures were mentioned. It is the level of differentiation between attacks.
Modern analyses have identified passages resembling phenomena we would now discuss in relation to tonic-clonic seizures, focal motor seizures, impaired-awareness seizures, absence-like events, prolonged or repeated seizures and even gelastic phenomena involving laughter.
Other passages appear to describe what today might be called prodromal symptoms, seizure precipitants, postictal states and interictal behavioural changes.
This does not mean Babylonian healers possessed a hidden version of modern epilepsy classification. They did not know about cortical networks, electrical discharges or neuronal function. The value of the text lies in the accuracy of observation, not in pretending that ancient categories map perfectly onto ILAE terminology.
The ‘falling disease’
Several ancient terms became associated with seizure disorders.
The Sumerian term antašubbû has often been translated as the ‘falling disease’. Akkadian terminology included miqtu, also connected with falling, while words built around ṣabātu could carry meanings related to seizing, grasping or possession.
The language itself reflects the way the condition was experienced: a person could suddenly fall, become overtaken by an event and appear to lose normal control of the body.
Later languages would repeatedly create epilepsy terminology around the same basic ideas of being seized, struck or falling.
Observation did not mean natural explanation
The Mesopotamian texts are sometimes presented as proof that ancient medicine was either completely scientific or completely superstitious. Neither description is adequate.
Babylonian scholars could observe neurological signs closely, distinguish patterns and make prognostic judgements. At the same time, many illnesses were understood within a world in which gods, demons, spirits, omens and ritual forces were considered real causes.
Epileptic attacks were particularly associated with supernatural agencies. Different seizure patterns could be attributed to different demons, spirits or divine ‘hands’.
From the Babylonian perspective, this was not necessarily a contradiction between medicine and religion. The supernatural world formed part of their explanation of reality.
Who treated illness?
Ancient Mesopotamian healing involved different kinds of specialists. Modern historians often distinguish the asû, who used remedies such as plant and mineral preparations, from the āšipu, who used diagnostic, ritual and incantatory practices.
The boundary was not equivalent to a modern division between ‘doctor’ and ‘priest’. The two approaches could coexist because physical remedies and supernatural explanations were not mutually exclusive within Mesopotamian culture.
For conditions interpreted as spirit or demon-related, ritual intervention could be a central part of treatment.
Did Sakikkū describe different seizure types?
Yes, in the limited historical sense that the text differentiates attacks according to what could be seen.
Some entries describe asymmetry: one side of the body, the eyes or the head behaving differently from the other. Others describe stiffness, jerking, collapse, altered awareness, vocalisation or unusual behaviour.
Modern neurologists reading these descriptions can recognise features that resemble seizure semiology still used today.
But retrospective diagnosis has limits. A symptom such as collapse or staring can have many causes, and translation from cuneiform introduces additional uncertainty. It is more accurate to say that some descriptions are compatible with modern seizure types than to claim that Babylonians had already identified today’s classifications.
Did they recognise focal seizures?
Some passages describe seizure activity beginning or predominating on one side of the body. This is historically fascinating because lateralised motor activity is one of the observations that, much later, helped neurologists understand focal seizure onset.
However, the Babylonian writers did not infer a focal electrical discharge in one cerebral hemisphere. Their interpretation remained embedded in the explanatory framework of their time.
The observation and the explanation must therefore be separated: they could see lateralisation without knowing why it occurred.
Did they describe prolonged seizures?
Parts of the Babylonian material appear to recognise attacks that continued or recurred and to associate some patterns with poor outcomes.
Modern historians have compared certain descriptions with status epilepticus. Again, caution is needed because ancient prognostic texts do not provide the timing definitions used in modern emergency neurology.
What they do show is that ancient observers recognised that not all seizure-like events carried the same prognosis and that prolonged or repeated attacks could be especially dangerous.
What about the period after a seizure?
The texts also contain observations resembling postictal phenomena — the altered state that can follow a seizure.
This is significant because it shows that an attack was not always treated as an isolated moment. Changes before, during and after the event could all become part of the clinical description.
Today, postictal confusion, sleepiness, weakness, memory disturbance, headache and behavioural change are recognised parts of seizure recovery. The ancient descriptions cannot be mapped neatly onto those modern categories, but the basic observation that the person may remain altered after the visible attack is very old.
Laughter and other unusual seizure phenomena
One passage analysed by Kinnier Wilson and Reynolds refers to prolonged loud laughter. They discussed whether the description could represent what would now be called gelastic epilepsy.
This is an excellent example of both the fascination and danger of retrospective diagnosis. Gelastic seizures are real and well described today, but an ancient report of laughter does not allow us to reconstruct the underlying lesion or syndrome.
It nevertheless shows that the Babylonian text did not restrict seizure illness to dramatic convulsions. Unusual behavioural manifestations were also recorded.
What did they know about the brain?
Very little in the modern neurological sense.
Mesopotamian scholars did not possess a theory of epilepsy based on cerebral electrical activity, cortical localisation or neuronal networks. Their neurological observations were therefore made without the anatomical framework that later medicine would develop.
This is one of the most remarkable aspects of the tablets: sophisticated bedside observation can exist before an accurate model of disease mechanism.
Were all seizures considered epilepsy?
The distinction between an isolated provoked seizure, recurrent unprovoked seizures and chronic epilepsy is a modern clinical framework.
The Babylonian texts used their own categories and causal explanations. We should therefore avoid imposing the current ILAE definition of epilepsy backwards onto individual ancient cases.
When historians call the tablet a treatise on epilepsy, they mean that the cluster of phenomena described corresponds closely to what later cultures and modern medicine have recognised as epileptic seizure disorders — not that the Babylonians were applying today’s diagnostic criteria.
Why clay tablets matter
Unlike many ancient medical traditions preserved only through later copying, cuneiform tablets can be archaeological objects from antiquity itself.
Important collections were recovered from sites including Nineveh and Nimrud. The library of the Assyrian king Ashurbanipal at Nineveh contained large numbers of scholarly and medical tablets copied during the seventh century BCE, preserving traditions that were often much older.
Because a copied tablet may preserve a text composed centuries earlier, historians distinguish the date of the surviving physical object from the date at which the underlying work was first compiled.
Why ‘the first description of epilepsy’ is too simple
Popular histories often want a single first: the first seizure, the first epilepsy text or the first doctor to understand it.
The evidence is more complicated.
Older Mesopotamian texts contain seizure-like descriptions. Sakikkū provides the oldest surviving detailed systematic account devoted to the condition as then understood. Earlier oral traditions are, by definition, unavailable to us, and other written material may have been lost.
The safest historical claim is therefore not that epilepsy ‘began’ in Babylon, but that Mesopotamia provides some of the earliest surviving written evidence for detailed human observation of seizures.
What this tells us about stigma
The supernatural explanations attached to epilepsy have a long legacy. Associating seizures with possession, dangerous spirits or divine forces could give attacks social meanings far beyond their physical symptoms.
However, it would also be wrong to draw a straight line from Babylonian belief to every later form of epilepsy stigma. Different societies developed different religious, medical and legal interpretations over thousands of years.
The Mesopotamian material is the beginning of a documented history, not a universal explanation for everything that followed.
From observation to explanation
The history of epilepsy repeatedly shows a gap between recognising what happens and understanding why it happens.
The Babylonian writers could identify recurring patterns. Greek medical writers would later argue over whether the disease was sacred or natural. Nineteenth-century neurologists would connect focal motor phenomena with cerebral localisation. Twentieth-century EEG would reveal electrical correlates of seizures. Modern neuroscience would move toward distributed epileptic networks.
The clinical event remained visible throughout. What changed was the explanatory model.
Why this page belongs at the beginning of the history
Ancient Mesopotamia gives us no modern theory of epilepsy, but it gives us something equally important for historical understanding: evidence that seizures were being watched, differentiated, recorded and interpreted more than three thousand years ago.
The tablets remind us that people with epilepsy existed long before modern diagnostic labels, and that the behaviours clinicians now call seizure semiology were observed centuries before anyone understood the electrical brain.
The next major change in this story would come from the ancient Greek medical tradition, particularly the text known as On the Sacred Disease, which argued that epilepsy should not be considered more divine than other illnesses.
Sources and further reading
Kinnier Wilson JV, Reynolds EH. Translation and analysis of a cuneiform text forming part of a Babylonian treatise on epilepsy. Medical History. 1990.
Eadie MJ. Epilepsy — from the Sakikkū to Hughlings Jackson. Journal of Clinical Neuroscience. 1995.
Fales FM. Mesopotamia. Handbook of Clinical Neurology. 2010.
Reynolds EH, Kinnier Wilson JV. Neurology and psychiatry in Babylon. Brain. 2014.
Chaudhary UJ, Duncan JS, Lemieux L. A dialogue with historical concepts of epilepsy from the Babylonians to Hughlings Jackson. Epilepsy & Behavior. 2011.
Magiorkinis E et al. The evolution of the concepts of seizures and epilepsy: What’s in a name? Epilepsia Open. 2020.
Kaculini CM et al. The History of Epilepsy: From Ancient Mystery to Modern Misconception. Cureus. 2021.
Historical evidence checked: September 2026.