William Gowers’ interpretation of epileptogenic mechanisms: 1880–1906

Summary In the 1870s, early in his neurologic career, William Gowers (1845–1911) was exposed to three main schools of thought concerning epileptogenesis, namely, that seizures resulted from (1) excessive neural activity in the medulla oblongata or pons (Marshall Hall, John Russell Reynolds, and Brown‐Séquard), (2) excessive local cerebral cortical activity (Hughlings Jackson), or (3) suddenly decreased cerebral activity that released the intrinsic contractibility of skeletal muscle (Radcliffe). By 1881, Gowers had reasoned his way to the idea that epileptogenesis was best accounted for by local cortical overactivity. This overactivity might at times be initiated by local loss of inhibition. The overactivity in turn then might inhibit other parts of the central nervous system to explain loss of consciousness in seizures and postseizure temporary hemiparesis. The possibilities of the idea of inhibition, at first often called “resistance,” continued to interest Gowers over the following 25 years. He settled on the synaptic gap as its likely site. However, the inhibition mechanism that he proposed, namely, retraction of dendrites, was rather extraordinary in the light of subsequent knowledge.