Summary: Purpose: Presentation of epilepsy suffered by Byzantine Emperor Michael IV, Paphlagon (who reigned from 1034 to 1041 A.D.) and the attitude of his contemporary society to his disorder.
Methods: Research into the accounts of Byzantine historians and chroniclers referring to the case of the emperor and Byzantine medical texts revealing the opinion of official medicine about the disorder.
Results: Byzantine historians and chroniclers provide detailed clinical descriptions of the seizures of Emperor Michael IV. Nearly all, expressing popular opinion, considered his disease to be demonic possession that constituted a form of divine punishment for the emperor's adultery and act of murder; his royal entourage continually attempted euphemistically to present this condition as a psychic disease. On the contrary, research into Byzantine medical texts reveals that the physicians, already from the 4th century, following Hippocratic tradition, believed that epilepsy was primarily a brain-related disorder and based their treatment on this etiological principle.
Conclusions: From the study of the Byzantine histories and chronicles, it can be deduced that Emperor Michael IV, Paphlagon, suffered from generalized tonic-clonic epileptic seizures. Despite the concept then held by well-educated Byzantine doctors, who considered epilepsy a brain disorder, information indicates the deep prejudices of his social environment.