Meduna and the origins of the idea that seizures can be therapeutic

Electroconvulsive therapy (ECT) has been well discussed in psychiatry as one of the oldest, yet still enduring and effective treatments for several psychiatric disorders, including depression, catatonia, mania, and psychoses. However, the intellectual history of ECT is much less known in the field of epilepsy, in spite of the fact that the therapy's origins are squarely in epilepsy neuropathology. Therefore, this historical review's primary aim is to retrace the scientific roots of ECT from a uniquely epilepsy-focused perspective. We focus on the key contributions of a neuropathologist studying epilepsy, László Meduna, who was the first to wonder if seizures may be beneficial in certain psychiatric disorders. In addition, we highlight the controversies surrounding his initial results, the transition from chemoconvulsants to electrical seizure induction, and that, despite the long-standing clinical use of ECT, it is still not well understood in mechanistic terms why inducing a seizure could relieve symptoms of certain psychiatric illnesses. The history of ECT for epileptologists is particularly insightful not only because it chronicles how an idea originating from studies focusing on seizures has come to have such an enduring impact on clinical care in an area outside of epilepsy but also because it highlights how bold testing of innovative hypotheses stemming from seemingly disconnected observations can lead to tangible breakthroughs in translation.