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Neurological letter from
Neurological letter from Marseilles
  1. Russell M Hewett
  1. Correspondence to Dr Russell M Hewett, Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, 1345 Govan Rd, Glasgow G51 4TF, UK; russell.hewett{at}nhs.net

http://dx.doi.org/10.1136/practneurol-2015-001325

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    You can see the connection between Marseilles and the study of epilepsy by just looking at the shape of Notre-Dame de la Garde

    On an early reconnaissance trip to Marseilles (figures 1 and 2), I was introduced to Professor Patrick Chauvel and Professor Fabrice Bartolomei. Both are leading clinical neurophysiologists at Hôpital La Timone, where I would spend two periods of my neurological training gaining experience in epilepsy and the presurgical assessment of epilepsy.

    Figure 1
    Figure 1

    Location of Marseilles. Image taken from Google Maps.

    Figure 2
    Figure 2

    Coat of Arms of Marseilles.

    As well as welcoming me wholeheartedly on that early visit, they reinforced the connection between epilepsy and Marseilles by demonstrating the obvious similarity between the highest monument in Marseilles—the cathedral of Notre Dame de la Garde—and the classic spike and wave electroencephalography (EEG) tracing (figure 3).

    Figure 3
    Figure 3

    The shape of the Notre Dame de la Garde and the ‘spike and wave’ superimposed.

    The earliest record of medical activity is found in the histories of the well-respected Greek physicians during the Roman times some 600 years after their Greek trader forebears had founded the city of Massilia.1 This makes Marseilles the oldest city in France and currently the second largest, as well as the capital of the ‘PACA’ region that covers the huge area of Provence, the lower Alps and the Côte d'Azur. It has developed a rich heritage as one of the major trading ports of the Mediterranean and with that a unique complex cultural identity.

    Twentieth century Marseilles saw the work of such celebrated physicians as Étienne-Louis Fallot (1850–1911) (figure 4), the cardiologist whose tetralogy bears his name and more significant to my own stay in Marseilles: Professor Henri Gastaut (1915–1995) (figure 5).

    Figure 4
    Figure 4

    Etienne Louis Fallot (1850–1911).

    Figure 5
    Figure 5

    Henri Gastaut (1915–1995).

    As well as defining major human EEG patterns, he championed semiology to describe seizures, individualised major childhood encephalopathies (the Lennox–Gastaut syndrome), and he was the first to develop and refine the present classification system. He was probably the leading figure to cement Marseilles onto the world map of epilepsy.2

    My plans to arrange training experience in Marseilles inevitably led to friends' accusations of lying on the beaches of the Côte d'Azur, bronzing under the southern French sun, while sipping Orangina or Rosé. However, St Tropez it is not.

    Marseilles has been considered akin in many ways to its sister British city of Glasgow—by the Marseillaise themselves! Both cities have a strong maritime history, flourishing in past centuries, but have endured a postindustrial period of depression, particularly in the mid-to-late 20th century with the associated increase in poverty, and inevitably crime.

    Marseilles differs from Paris in accent, culture and distance, to the same degree that Glasgow does from London!

    However, whereas Glasgow is now developing into a major centre for clinical epilepsy, Marseilles has been an internationally renowned clinical and research centre for epilepsy for many decades. Furthermore, it is one of the worldwide leading centres for intracranial stereotactic EEG for presurgical assessment, which was originally developed in France.

    Indeed, this is the second strand to the history of epileptology in Marseilles, completely independent of the work, literature and philosophy of Gastaut. This was forged by Patrick Chauvel who was the direct pupil of Jean Talairach and Jean Bancaud at the Centre Hospitalier Sainte Anne in Paris who created the method of stereoelectroencephalography (SEEG) in the 1960s and 1970s.3 Patrick Chauvel has been largely responsible for the ongoing development of SEEG in all French centres.

    His influence spread to the UK via Glasgow and the initiation of ‘Franco-Scottish’ epilepsy meetings. This strong relationship certainly facilitated my period of training there.

    My time was spent predominantly at Hôpital La Timone in central Marseilles (figure 6). This is the base of the clinical neurophysiology and video telemetry unit, which is a huge adult and paediatric hospital that also houses the impressive ‘Institut de Neurosciences des Systèmes’, which is a multidisciplinary research institute of Institut National de la Santé et de la Recherche Médicale (National Institute for Health and Medical Research).

    Figure 6
    Figure 6

    Hôpital La Timone.

    There are four video telemetry beds for scalp EEG and intracranial depth electrode recordings. Also patients with intracranial depth electrodes undergo stimulation to help confirm the epileptogenic zone of the brain and delineate the eloquent language, motor and sensory cortices.

    The unit has a steady throughput of French and international neurology ‘internes’, who have the opportunity to attend clinical neurophysiology lectures and tutorials as well as observe, clerk in and present the patients at numerous multidisciplinary meetings—each known as ‘le staff’. These meetings consider and discuss the semiology, imaging, neuropsychology and neurophysiology of each case in order to consider the surgical options and implantation plan. The patients themselves are mostly French, but there are some Spanish and Italian patients who are sent for second or third opinions. Patients have also been sent from Glasgow and London to Marseilles.

    Marseilles also boasts the Hôpital Henri Gastaut (figure 7), which is a small hospital east of La Timone, devoted to the diagnosis, management and research of epilepsy. It is similar to Chalfont Epilepsy Centre just outside London and to the William Quarrier Scottish Epilepsy Centre in Glasgow, in which there are further video telemetry beds, clinic rooms and longer-stay patients. There is no shortage of experience in epileptology in Marseilles.

    Figure 7
    Figure 7

    Hôpital Henri Gastaut.

    The local team managed to lodge me in semiconstructed nurses’ accommodation (cue ‘Carry On Nurse’ jokes) that houses visiting fellows and students. These were fantastically cheap rooms with kitchenettes, but I had to borrow a mattress surreptitiously from an empty room, and to purchase electric heaters and extra blankets to combat the incredible cold that was brought down from the Alps in the form of ‘Le Mistral’ wind during January.

    Marseilles itself is an adventure. It is colourful, diverse, creative and gritty. It has the hard-edged darker side of any city that has been a major port and anyone who desires a Niçois-type holiday may want to go east towards Cannes. However, the Vieux-Port (figure 8) has a picture-postcard marina, and the beautiful fjord-like ‘Calanques’ (figure 9) that lie just a 10 minute bus journey away on the south edge of the city. And for those who are passionate about football, the local team Olympique Marseilles is known to have some of the most raucous supporters in all of Europe.

    Figure 8
    Figure 8

    Vieux-Port.

    Figure 9
    Figure 9

    Les Calanques.

    Spending part of your training abroad allows you to develop new skills and understand alternative approaches to your specialty; it also allows the exploration of a different culture. During my time in Marseilles, I was fortunate enough to learn from a team that helped me develop and foster my burgeoning interests in epileptology, and also created professional links, future projects and lasting friendships. I think I also vastly improved my ‘Franglais’!

    Question

    Anyone that spends time in another country, and is not fluent in the language, knows that following the flow of conversation during initial meetings is near impossible. It is not the speed of delivery that causes the problem, but the use of medical jargon. Here is a quiz.

    1. Déjà vu (easy one).

    2. Déjà-vécu.

    3. Crises épileptiques.

    4. L’état de mal.

    5. Les pertes de connaissance.

    6. Troubles végétatifs.

    7. Une morsure latérale de langue.

    8. Une rupture du contact.

    Answers

    1. and 2. In fact the French say ‘Déjà vu, Déjà-vécu’ or ‘DVDV’—already seen, already lived.

    3. Epileptic seizures.

    4. Status epilepticus.

    5. The loss of consciousness.

    6. Autonomic features.

    7. A bite to the side of the tongue.

    8. Loss of responsiveness.

    Acknowledgments

    The author is very grateful for the input of Professor Patrick Chauvel and Dr Aileen McGonigal.

    References

    1. ↵
      1. Duchêne R,
      2. Contucci J
      . Marseille 2600 year of history (in French). Paris: Editions Fayard, 1998.
    2. ↵
      1. Darvet C,
      2. Roger J
      . In Memoriam: Henri Gastaut 1915–1955. Epilepsia 1996;37:410–15. doi:10.1111/j.1528-1157.1996.tb00580.x
      OpenUrlPubMed
    3. ↵
      1. Talairach J,
      2. Bancaud J,
      3. Szikla G, et al
      . Approche nouvelle de la neurochirugie de l'epilepsie. Méthodologie stéréotaxique et résultats thérapeutiques. Neurochirurgie 1974;20(Suppl 1):1–240.
      OpenUrlPubMed
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    Footnotes

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed. This paper was reviewed by Colin Mumford, Edinburgh, UK.

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