Was Julius Caesar's epilepsy due to neurocysticercosis?
Was Julius Caesar’s epilepsy due to
Department of Experimental Pathology, M.B.I.E., Universita ` di Pisa, Medical School, Via Roma, 55, 56126 Pisa Italy
Julius Caesar (100–44 BC) had epileptic crises. The Greek
writer Plutarch (AD 75) reported, in fact, that he was
historian Svetonius (119 BC) referred to him as having
excellent health; nevertheless, at the end of his life he
underwent sudden falls, and he was suffering sleep dis-
Several epileptic crises were described for the Roman
general,the first in 46 BCin Thapsus, modernTunisia, one
year after his first travel to Egypt, and the second referred
to by Plutarch which occurred in Cordoba, Spain, when
Caesar was over 50 years of age. After his travel back to
Rome from Egypt, two more episodes of partial crises were
described, during the assembly at the Roman Forum,
which have attracted the interest of authors of tragedies,
including Shakespeare (Julius Caesar, Act 1, Scene 2:
Casca to Brutus speaking about Caesar, ‘‘for he swounded
and fell down at it...’’ And later Casca says, ‘‘He fell down
in the market place, and foamed at mouth and was speech-
sickness’’), and screenwriters of movies and TV fiction.
Thus, the epilepsy of Caesar appeared late in his life,
suggesting an acquired rather than a congenital nature,
despite the familiarity of such crises (his son Caesarion,
born by Cleopatra VII, suffered from epilepsy since infant-
hood, as well as other descendants such as Caligula and
Furthermore, epileptic crises of Julius Caesar were
described as partial at the onset, and not generalized, as
would be expected more typically in the presence of a
genetically determined epilepsy.
If the disease of Caesar was acquired, what might be the
possible causes? The Canadian neurologist McLachlan 
has evaluated all possible causes of acquired epilepsy.
Among the most corroborated etiological hypotheses in
the past, there were those related to chronic infectious
diseases such as neurosyphilis, in consideration of the in-
tense sexual activity of the Roman general, cerebral tuber-
culosis, typhus and malaria , as Julius Caesar travelled
frequently in geographical areas where he was at risk.
Another hypothesis to explain epileptic crises, in con-
sideration of the age of first manifestations, is related to a
benign tumor (meningioma or glioma) . In any case,
epileptic manifestations were not accompanied by a dete-
rioration of the cognitive functions of the dictator, who was
still able to adequately carry out his functions as senator
until his murder in 44 BC. Although information on
Caesar’s life should be always evaluated with caution
because of legend aura surrounding this important histor-
ical personage, no information is available attributing his
epilepsy to other possible causes of acquired epilepsy such
as trauma or stroke. However, the head asymmetry in the
Tusculum portrait, possibly the only surviving bust of
Caesar made during his lifetime, has been interpreted
as evidence of trauma that occurred early in his life.
Finally, by exclusion, the possibility of neurocysticerco-
sis has been considered by McLachlan , because this
disease could be asymptomatic, for years, with the excep-
tion of crises. Neurocysticercosis is the cerebral localiza-
tion of the larval stage (cysticercus) of the human cestode
Taenia solium. At present, neurocysticercosis at a global
level represents the first cause of acquired epilepsy .
This hypothesis originates also because before the ap-
pearance of the well-documented comitial episodes, Julius
Caesar was travelling in Egypt where T. solium was
present at that time, as shown by the description of the
most ancient case of cysticercosis in an Egyptian mummy
of the first century BC, the so-called mummy of Narni .
Furthermore, Taenia spp. ova were found in the intestinal
tract of an Egyptian male buried in the first half of the
twelfth century BC [known as the mummy of Nakht, ‘the
weaver of the funerary temple of the Pharaoh Setnakht’
(1184–1181 BC)] .
The farming of swine was practiced in Hellenistic Egypt,
probably for consumption of meat, as shown in several
pictures originating from Egyptian civilization . The
pig was considered sacred as it represented the totem ani-
mal of Osiris; consequently, consumption of pork was for-
bidden except on the holy day dedicated to this God, when
even poor people, unable to buy pork, prepared cakes re-
sembling pigs .
According to McLaclan , Caesar might have been
infected while traveling in regions of Southern Europe
where the parasite was known to inhabit as infection in
swinewasdescribed byAristotle’s Historiaanimalium. The
hypothesis of neurocysticercosis is undoubtedly intriguing,
but it is based on exclusion criteria. Unfortunately, it is
impossible to perform neuroimage analysis or serological
tests on Caesar to have a confirmation of such a diagnosis.
The Author is indebted to D. Puliga and G. Ricci for providing information
derived from classical literature.
1 McLachlan, R.S. (2010) Julius Caesar’s late onset epilepsy: a case of
historic proportions. Can. J. Neurol. Sci. 37, 557–561
Corresponding author: Bruschi, F. (firstname.lastname@example.org).
2 Gomez, J.G. et al. (1995) Was Julius Caesar’s epilepsy due to a brain
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3 Garcia, H.H. et al. (2003) Taenia solium cysticercosis. Lancet 362,
4 Bruschi, F. et al. (2006) Short report: cysticercosis in an Egyptian
mummy of the late Ptolemaic period. Am. J. Trop. Med. Hyg. 74,
5 Millett, N.B. et al. (1998) ROM I: mummification for the common people.
In Mummies, Disease and Ancient Cultures (Cockburn, A. et al., eds), pp.
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1471-4922/$ – see front matter ? 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.pt.2011.06.001 Trends in Parasitology, September 2011, Vol. 27, No. 9
Trends in Parasitology September 2011, Vol. 27, No. 9