Epilepsia, 37(4):410-4 15, 1996 Lippincott-Raven Publishers, Philadelphia 0 International League Against

In Memoriam 19 15-1 995

Charlotte Dravet and Joseph Roger

Centre Saint-Paul, Centre HGspitalier SpPcialisk pour L’Epilepsie, ,

“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 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 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 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. Colloquium (6). He was also interested in the psy- After World War 11, at the urging of William G. chological and behavioral manifestations of epi- Lennox, Gastaut founded the FLAE in 1949 and lepsy and organized several meetings on the rela- served as its President until 1973. The FLAE was tion between EEG and behavior. the sixth chapter of the ILAE. Gastaut organized Not all paroxysmal phenomena are epileptic, and the 7th International Epilepsy Congress, which was Gastaut was concerned about accurate differential held in in conjunction with the International diagnosis. To this end, he conducted a series of Congress of EEG and Clinical Neurophysiology . studies of syncope, sleep disorders, and autonomic After the 7th International Congress, he established phenomena that became seminal contributions. He the principle of a quadrennial meeting for all neuro- was an early proponent of the importance of epide- logical science societies, including the ILAE. Gas- miological research, and his 1968 symposium on taut was named President-Elect of the ILAE in 1953 Epilepsy in Africa was the starting point for many and spent several months in South America and Ja- later surveys of epilepsy in developing countries pan helping develop ILAE chapters in those areas. (7). He served as ILAE’s Secretary General from 1957 to 1969, and he became its President in 1969, a term CONTRIBUTIONS TO PATIENTS that ended in 1973. There is little question that Gas- taut introduced new vigor into the ILAE. He played Gastaut understood that seizures and epilepsy a leading role in reorganizing Epilepsia, which had were not abstract concepts but conditions that vi- not been published since 1955. The first volume of tally affected patients and their families. Although the fourth series appeared in 1959 with Gastaut, much of his work was scientific, Gastaut was Gilbert Glaser, and Albert Lorentz de Haas as co- deeply committed to improving the well-being and editors. Gastaut was instrumental in reestablishing quality of life not only of his own patients but of Epilepsia as the main forum for clinical and exper- everyone afflicted with epilepsy. He recognized the imental publications related to epilepsy. He greatly antiepileptic properties of the benzodiazepines and enhanced the journal’s prestige by preferentially was a strong advocate for their use not only to ter- submitting his own papers to it and urging his col- minate status epilepticus but also to treat patients leagues and co-workers to do the same. He was a with chronic epilepsy. His studies of childhood ep- founding member of the International Federation of ilepsies led to the development of specialized facil- EEG and Clinical Neurophysiology and served both ities that provided comprehensive, multidisci- as its Secretary (1949-1957) and then its President plinary care, and education. In 1958, together with (1957-1961). Drs. P. and M. Kerfriden, he founded the Toul-ar- choat Center for education of children with epilepsy THE MARSEILLE COLLOQUIA in Brittany. At the same time, he spearheaded the formation of a working group within the WHO on Gastaut founded the Marseille Colloquia, meet- the importance of education about epilepsy. With ings that under his direction became internationally the help of Madame Germain Poinso-Chapuis, the known as premier forums for promoting epilepsy

Epilepsia, Vol. 37, No. 4, 1996 IN MEMORIAM 413 research, developing consensus views about partic- mulated numerous honors and awards. He was a ular issues, defining critical research questions, and corresponding member of the AcadCmie FranGaise providing state-of-the-art clinical and scientific re- de Medecine, Commandeur of the Ordre National views (Fig. 2). The Colloquia were held almost ev- du Merite, Commandeur of the Ordre of the Palmes ery year, from 1950 to 1980, and each attracted 300- Academiques. He received the Prix Monthyon of 500 participants. Meetings were chaired by re- the Academie des Sciences. An officer of the LC- nowned neurologists or neurophysiologists, includ- gion d’Honneur, he had been elevated to the grade ing Alfred Fessard, W. Grey Walter, Herbert Jas- of Commandeur shortly before his death. He was a per, Theophile Alajouanine, Wilder Penfield, and corresponding member of the American Neurolog- Karl Zulch. The last Colloquium, in 1980, was ical Association and an honorary member of the chaired by Roger Broughton of Ottawa, who was American Academy of Neurology, the Belgian one of Gastaut’s first students in Saint-Paul who Royal Academy of Medicine, and the National was not from France. The proceedings of this final Academy of Medicine of Buenos-Aires, as well as Colloquium were published under the title: Henri of many other national neurology and epilepsy so- Gastaut and the Marseille School’s Contributions cieties. He received honorary doctorates from the to the Neurosciences (8). Even after the Colloquia Universities of Bologna, Liege, Ottawa, and Shang- had ended, Gastaut continued to hold annual meet- hai. ings, attended by many French and foreign neurol- ogists, to review topics in epilepsy and EEG and STUDENTS AND COLLABORATORS discuss interesting cases, both his own and those presented by participants. In this activity, he was From the earliest days, Gastaut attracted the best invariably aided by his devoted secretary, Mireille students and eminent co-workers. From France, Taury. He brought the same level of energy, dedi- these included Robert Naquet, Henri Regis, and cation, and enthusiasm for teaching to these smaller Robert Vigouroux in neurophysiology; George meetings as he did to the great international con- Salamon in neuroradiology; Maurice Toga in neu- gresses. ropathology ; Joseph Roger, Anne Beaumanoir, Micheline Vigouroux, Maurice and Suzanne Don- HONORS AND AWARDS gier, Carlo Albert0 Tassinari, Rene Soulayrol, Needless to say, Gastaut’s contributions were Michelle Bureau, and in epileptol- recognized repeatedly, and over the years he accu- ogy. Gastaut’s achievements and great reniltatinn

FIG. 2. Gastaut (front row, center) with participants at the 1964 Marseille Colloquium.

Epilepsia, Vol. 37, No. 4, 1996 414 IN MEMORIAM made Marseille a magnet for neurologists and neu- the collection to the Vieille CharitC Museum of rophysiologists from around the world. It is impos- Marseille. sible to name them all without inadvertently omit- ting some. Suffice it to say that Gastaut was partic- CONCLUSION ularly linked to Italy and Spain, and that there are numerous former students of his in these countries All of the foregoing is but the briefest summary of who continue his work and teaching. Epileptolo- a full, intensely active life made possible by excep- gists around the world who were trained by Gastaut tional intelligence, enormous capacity for work, an or who collaborated with him are sufficiently nu- ability to identify the critical issues unerringly, and merous and have had sufficient impact in the field an extraordinary gift for communicating complex that they are known collectively as the Marseille issues clearly. No one who participated in a meeting School. with Gastaut will ever forget the experience (Fig. 3). He was always frank, and he never hesitated to CONTRIBUTIONS TO ART AND CULTURE contradict a speaker or interlocutor. This guaran- teed that discussions, whether large or small, were A person of Gastaut’s personality and energy always lively, frequently argumentative, even tu- could not confine himself only to medicine and sci- multuous but, at the same time, always profitable ence. Indeed, he had an insatiable curiosity for all and rarely rancorous. His humor and great expres- human activities, especially those in art and litera- sive ability were usually effective in diffusing anger ture. He tried to understand possible links between and bitterness. Even those who disagreed with him epilepsy and artistic genius in persons such as Fe- recognized his unique qualities and contributions. It dor Dostoyevski, Gustave Flaubert, and Vincent was truly a fascinating experience to work with Van Gogh, and he published several papers about him! At the very end of his life, still lucid and in- this relationship. His research brought him into sightful, he was able to criticize his own work and close contact with the cultural world, and he be- took delight in seeing the reaction when he would came knowledgeable about literature and the fine announce that “only a minority of my studies had arts. He and his wife Yvette collected books, paint- any real interest”! ings, furniture, jewels, and other art works from We cannot conclude this tribute without ac- around the world. Gastaut also had a long-standing knowledging Henri Gastaut’s wife, daughter, and interest in the human skull and the worship and rites twin sons. His was a close family, and Gastaut was surrounding it in primitive cultures. He assembled a deeply attached to all of them. They participated in unique collection of rare specimens which he dis- all of his activities. He was proud to see his chil- played in his home office and which gave him great dren’s accomplishments, which include professor- pleasure to show. At the end of his life, he donated ships in neurology and hematology.

FIG. 3. Gastaut in a lively dis- cussion at University Hospital La Tirnone with Dr. Carlo A. Tassinari, Dr. Joseph Roger, and L. Bollis (of the World Health Organization) (left to right).

Epilepsia, Vol. 37, No. 4, 1996 IN MEMORIAM 415

With Henri Gastaut’s passing, the world has lost national League Against Epilepsy. Proposal for revised clas- sification of epilepsies and epileptic syndromes. Epilepsia an incomparable personality and genius. 1989;30:389-99. 5. Fishgold H, Gastaut H, Rayons X. Radioisotopes et EEG REFERENCES dans l’epilepsie. Electroencephalogr Clin Neurophysiol 1960;(s~ppl17): 1-266. 1. Commission on Terminology of the International League 6. Gastaut H, Gastaut JL. Computerized transverse axial to- Against Epilepsy. A proposed international classification of mography in epilepsy. Epilepsia 1976;17:325-36. epileptic seizures. Epilepsia 1964;5:297-306. 2. Gastaut H. Clinical and electroencephalographic classifica- 7. Gastaut H. Epidemiologie de l’epilepsie en Afrique. Afr J tion of epileptic seizures. Epilepsia 1970;ll:102-13. Med Sci 1970;1:115-251. 3. Gastaut H. Dictionary of epilepsy. World Health Organiza- 8. Broughton RJ. Henri Gastaut and the Marseille School’s tion, Geneva, 1973. Contribution to the Neurosciences. Electroencephalogr Clin 4. Commission on Classification and Terminology of the Inter- Neurophysiol 1982;(suppl 35): 1-447.

Epilepsia, Vol. 37, No. 4, 1996