THUR 052 Epilepsy in the land of ice and fire

BackgroundEpilepsy is often explained through allegory; from magical thinking to misfiring neurons. It is important to appreciate pervasive media portrayals which influence lay attitudes toward epilepsy. George R. R. Martin’s series of fantasy novels A Song of Ice and Fire, and the HBO television adaptation A Game of Thrones, introduce characters with ‘mundane’ and ‘mystical’ epilepsy to millions. Cases are presented to highlight these varying portrayals.CasesRA, 8 years old, has ‘shaking sickness’. Triggered by stress, his hands ‘shake’ with subsequent involvement of all limbs. He loses consciousness, is incontinent of urine, and demonstrates post-ictal confusion. He is enmeshed with his mother and his condition is viewed as a manifestation of his unsuitability to rule.BS fell at 9 years old, resulting in a coma. Subsequently he remains paraplegic with dialeptic episodes. During absences, he can ‘possess’ animals or people, and experiences impossible hallucinations. These abilities are portrayed as empowering for a boy who suffers heavy stigma against physical disability.ConclusionFans will probably not adopt ‘magical’ views but may internalise stigma weighed against characters with both ‘mundane’ and ‘magical’ epilepsy. Due to the large audience, clinicians working with epilepsy patients might benefit from awareness of these portrayals.