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Henri Gastaut 19 15-1 995 Epilepsia, 37(4):410-4 15, 1996 Lippincott-Raven Publishers, Philadelphia 0 International League Against Epilepsy In Memoriam Henri Gastaut 19 15-1 995 Charlotte Dravet and Joseph Roger Centre Saint-Paul, Centre HGspitalier SpPcialisk pour L’Epilepsie, Marseille, France “J’airnerais rnieux ne rien dire the new technique of EEG to study normal and ab- que rn’exprimer faiblement. ” normal cortical function, and in 1953 he became Head of the Neurobiological Laboratories at the Van Gogh Marseille Hospital. In recognition of his outstand- ing contributions in EEG and related fields, a chair Henri Gastaut died in July 1995, at home in in clinical neurophysiology was created for him in Marseille, at the age of eighty. His death was a great 1973, and he held the permanent position of Profes- loss to the international epilepsy community, for his sor of Clinical Neurophysiology from 1973 until his contributions knew no national boundaries. There retirement in 1984. are few names that are as synonymous with epi- In 1967, Gastaut’s colleagues elected him Dean of lepsy as his: he was one of the great pioneers who the University of Marseille School of Medicine. The established epileptology as a respected discipline wisdom of this choice was proved in 1968, when within neurology and whose contributions ad- Gastaut’s exceptional intelligence, diplomacy, and vanced the knowledge and treatment of epilepsy communication skills allowed him to navigate suc- enormously (Fig. 1). His intelligence was so keen cessfully that period of student unrest and political and his personality exceptional that no one who so turmoil and to lead the medical school community met him could ever forget the encounter. into the quieter era that followed. In 1971, he was elected President of a new, sec- ACADEMIC CAREER ond branch of the University of Aix-Marseille which he had helped organize. He served as Presi- Henri Gastaut was born in Monaco on April 15, dent of the National Conference of French Univer- 1915. After obtaining a graduate degree in the nat- sity Presidents for 2 years, a time of accomplish- ural sciences, Gastaut obtained his medical degree ment due to his administrative skills. He became from the University of Marseille. Early in his med- extremely influential both with his academic peers ical studies, he manifested the enormous thirst for and the important government ministries. knowledge and appetite for intellectual challenges From 1960 to 1972, Gastaut’s clinical and aca- that characterized his entire professional life. He demic activities were divided between the Univer- specialized in neurology under the tutelage of Pro- sity Hospital La Timone and the Centre Saint-Paul. fessor Henri Roger and simultaneously engaged in During the same time, he was Head of one of the specialized studies of normal and morbid neuro- units of the National Institute for Medical Research anatomy under the direction of Professor Lucien (INSERM) which was dedicated to epilepsy. In Cornil, then Dean of the University of Marseille 1984, he created the Institute of Neurological Re- School of Medicine. search, a center that was cosponsored by the World He was appointed associate professor (“agrCgC”) Health Organization (WHO), which Gastaut served at the University and then succeeded Cornil as Pro- as an important consultant. fessor of Pathological Anatomy. However, Gastaut had already recognized the possibilities for using ACHIEVEMENTS IN EEG AND CLINICAL RESEARCH Received February 1, 1996. Address correspondence to Dr. C. Dravet at Centre Saint- Paul, 300 Boulevard de Sainte-Marguerite 13009 Marseille, EEG was Gastaut’s passion. He trained with W. France. Grey Walter in Bristol, and he understood from his 410 IN MEMORIAM 411 pects of seizures and epilepsy. Seizure semiology was a particular interest. Stimulated by a stay at the Montreal Neurological Institute, he refined the de- scription of seizures of temporal lobe origin and reported the behavioral manifestations of seizures occurring after stimulation of temporolimbic struc- tures in experimental animals. He described unilat- eral seizures, tonic seizures, atonic seizures, and typical and atypical absence seizures. Beyond sei- zure semiology, however, Gastaut was committed to understanding and elucidating the complete phe- nomenology of different types of epilepsy. His work in photosensitivity led naturally to studies of a group of photosensitive epilepsies and, among these, his careful definition and delineation of pa- tients with self-induced photosensitive seizures and those with television-induced seizures deserve spe- cial note. He also described startle epilepsy and ep- ilepsy manifested by hemiconvulsions and associ- ated with hemiplegia (HHE syndrome). By recog- nizing essential common features, he individualized one of the most malignant childhood epileptic en- cephalopathies, the Lennox-Gastaut syndrome. As a major contributor to a large international collab- orative study and as a singular presence at a subse- FIG. 1. Gastaut lecturing and commenting during a meet- quent international meeting, Gastaut was a vital cat- ing. alyst in providing a modern definition of West’s syndrome. His last important clinical discovery was first studies the unique opportunity that EEG of- identifying benign partial epilepsy of childhood with fered for studying brain function, especially as it occipital spike-waves. related to epilepsy. Between 1947 and 1987, Gastaut Gastaut’s research did not result only in a collec- was the driving force behind an uninterrupted series tion of facts or observations about new phenomena. of major contributions concerning neurophysiology On the contrary, he always tried to understand the and epilepsy. context and to integrate his findings into a more With his wife Yvette as his close collaborator, global understanding of brain function and epilepsy, Gastaut defined five of the major human EEG pat- in all its aspects. Early in his career, he understood terns recognized by the International Federation of the critical need for classifying seizures and differ- EEG and Clinical Neurophysiology : lambda waves, ent kinds of epilepsy based on their most important mu rhythm, pi rhythm, posterior theta rhythm, and characteristics. Over the years, he progressively rolandic spikes. He established several methods for elaborated and refined a comprehensive nosology activating abnormal EEG discharges, including that is the basis of our present classification sys- photic stimulation and photic-pentylenetetrazol ac- tems. His classification of epileptic seizures was the tivation. He used EEG to study the relation be- focus of the 1964 Marseille Colloquium (1). Subse- tween cortical physiology and various states of al- quently, the Commission on Terminology of the In- tered consciousness, including both those he con- ternational League Against Epilepsy (ILAE) re- sidered natural (meditation, ecstasy, oriental mystic viewed the proposal at meetings in Hemstede and techniques), as well as those he termed artificial Vienna. Gastaut then integrated the various com- (psychoactive drugs, biofeedback). He also studied ments, suggestions, and criticisms into a revised Pavlovian and operant conditioning and made major version which was approved at the 12th Interna- contributions to understanding of the clinical man- tional Epilepsy Congress in New York in 1967, for- ifestations and physiological correlates of the para- mally adopted by the ILAE in 1969, and published somnias (pavor nocturnus, somnambulism, enure- in 1970 (2). Recognizing that epileptologists needed sis). to use a common language in which words are rec- Always and above all, Gastaut was an epileptol- ognized as having specific meanings, Gastaut began ogist, and his work addressed almost all clinical as- a Dictionary of Epilepsy in 1964. This work under- Epilepsia, Vol. 37, No. 4, 1996 412 IN MEMORIAM went a long development before being published by former Minister of Health for France, Gastaut cre- the WHO in 1973 (3). ILAE’s Classification of Ep- ated the Centre Saint-Paul in Marseille in 1960 and ilepsies and Epileptic Syndromes, adopted in 1989, directed it for the next 10 years. Like his Neuro- also had its origin in Gastaut’s earlier proposals (4). physiology Department at La Timone, the Centre We cannot sufficiently emphasize Gastaut’s com- Saint-Paul under Gastaut’s leadership became the prehensive view of epilepsy. His strong background crucible for many original ideas, research that con- in anatomy led him to seek clinicopathological and tributed significantly to our understanding of epi- physiopathological correlations wherever possible. lepsy and to advanced patient care that benefited In 1958, he dedicated the Marseille Colloquium to children with epilepsy everywhere. understanding the relationship between neuroradi- ological and EEG findings in the epilepsies (5). CONTRIBUTIONS TO THE FRENCH LEAGUE When computed tomography (CT) of the brain was AGAINST EPILEPSY (FLAE) AND THE ILAE introduced, Gastaut recognized its importance im- Gastaut’s views and contributions were never pa- mediately and arranged through the WHO to have rochial. He was devoted to epilepsy not only in one of the first machines installed in the Hospital La Marseille, but also throughout France and, indeed, Timone for investigation of all patients with epi- the world. He believed strongly that medical and lepsy. The role of CT and its emerging contribution scientific advances must be communicated as to epileptology was the theme of the 1975 Marseille widely as possible.
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