The epilepsy of Emperor Michael IV, paphlagon (1034-1041 AD): Accounts of Byzantine historians and physicians

Purpose: Presentation of epilepsy suffered by Byzantine Emperor Michael IV, Paphlagon (who reigned from 1034 to 1041 A.D.) and the attitude of his con temporary society to his disorder. Methods: Research into the accounts of Byzantine historians and chroniclers referring to the case of the emperor and Byzantine medical texts revealing the opinion of official medicine about the disorder. Results: Byzantine historians and chroniclers provide de tailed clinical de scriptions of the seizures of Emperor Michael IV. Nearly all, expressing po pular opinion, considered his disease to be demonic possession that constit uted a form of divine punishment for the emperor's adultery and act of murd er; his royal entourage continually attempted euphemistically to pre-sent t his condition as a psychic disease. On the contrary, research into Byzantin e medical texts reveals that the physicians, already from the 4th century, following Hippocratic tradition, believed that epilepsy was primarily a bra in-related disorder and based their treatment on this etiological principle . Conclusions: From the study of the Byzantine histories and chronicles, it c an be deduced that Emperor Michael IV, Paphlagon, suffered from generalized tonic-clonic epileptic seizures. Despite the concept then held by well-edu cated Byzantine doctors, who considered epilepsy a brain disorder, informat ion indicates the deep prejudices of his social environment.