Bringing CNS Members Together to Make Children’s Lives Better


Cesare Lombroso, MD, PhD

Cesare Lombroso, MD, PhD

Cesare Lombroso, born in 1917, spent his childhood in Rome, Palermo and Torino. His family included numerous distinguished writers and scientists. His father was a physiologist and his grandfather, for whom young Cesare was named, had been the first professor of mental diseases at the University of Pavia. Grandfather Cesare had been interested in neurological consequences of dietary deficiencies and was the internationally recognized founder of the science of criminal anthropology. He is said to have been the person who first attracted medical student, Camillo Golgi to the study of neuroscience. It is not surprising that as a teenager, Cesare Lombroso undertook bench investigations of the effects of various perturbations (autonomic manipulations, heat and cold, hormonal vitamin C, malnutrition) on intermediary metabolism and other homeostatic functions. His studies included investigation of the role of the sympathetic nervous system in winking and autonomic aspects of digestion and temperature regulation. Although he received his degree from the Garibaldi Lyceum in Palermo, the studies were interrupted when the Lombrosos were compelled to move to Paris in 1937 as a result of his father’s refusal to declare support for Mussolini. Young Cesare, himself, was active in an antifascist youth league.

Nine papers, published between 1936 and 1939, resulted from Lombroso’s early research The last of these, concerning physiological effects of malnutrition, was published in Biochemische Zeitung and was awarded the Lattes Prize in 1939. As WWII broke out Lombroso moved to the United States to attend the Johns Hopkins Medical School from 1939-1941, paying for his first year’s studies with a cash award received in a poetry contest. As the US entered the war, Lombroso jumped at the opportunity to place his strong anti-fascist sentiments into action. He served from 1941-1944 in the Office of War Information and the Office of Strategic Services (precursor to the post-war CIA). In Europe, the OWI served much the same function that Radio Free Europe would after the war. Lombroso became the Co-Chief of the Italian Short Wave Program. He also became a member of the Council of Free Italy, Vice-President of the Mazzini Society, and Co-Editor of Nazione Unite, a publication that championed Italy’s resistance movement. He encountered and married a similarly devoted champion of the redemption of Europe from the Fascist tyranny, Polish émigré, Riesa.

In 1945, Lombroso returned to Italy to take his medical degree from University of Genoa in 1946. He resumed his physiological investigations, characterizing a novel liver factor involved in lipid metabolism. Earlier work on this had earned him the prestigious Schering Award in 1942. The full results of his studies were published in Science in 1948. Dr. Lombroso completed a two-year residency in pediatrics at Genoa in 1950, under the direction of Professor Giovanni deToni, the highly distinguished physician and physiologist whose investigations of infantile nephrosis, renal tubular acidoses, and deamination disorders, identified the deToni-Debre-Fanconi syndrome. Dr. Lombroso’s interests in alimentation prompted clinical studies of cystic fibrosis and of protein metabolism in malnourished children. Always keen to improve the lot of children, he developed and tested casein-derived feeding supplements for oral and parenteral administration. He was thus a pioneer of hyperalimentation. In the laboratory of Professor Arturo Bonsignore he investigated autonomic regulation of protein catabolism. Dr. Lombroso published eight papers from 1948-1950 reflecting his diverse clinical and experimental activities, and was awarded Ph.D. in physiology from the University of Rome in 1951.

In 1950 Dr. Lombroso moved to the new Seizure Unit at Boston Children’s Hospital, becoming William Lennox’s first epilepsy fellow. Dr. Lombroso sought, as always, to acquire as much basic science and clinical knowledge as possible. The importance of combining clinical setting, close semiological observation, and electrophysiological excellence was manifested. He viewed all three elements as necessary and indivisible attainments of the epileptologist, attaining exceptional skill in each of these aspects. He would retain as well his early interest in basic science. In 1953, Dr. Lombroso undertook research on the cortical mechanisms of reflex myoclonus with Jerome Merlis and Alexander. This work, which resulted in six publications, was supported by one of the early NIH Career Development Fellowships. Dr. Lombroso’s interest in the broad spectrum of neurological disease and neuropathology led him in addition to spend parts of four years (1953-1957) under Raymond Adams at the Massachusetts General Hospital. He was certified by the American Board of Psychiatry and Neurology in 1956. Dr. Lombroso also assumed increasing responsibility in the Seizure Unit. With Dr. Lennox’s retirement (and shortly afterwards, his death), Dr. Lombroso was appointed (in the usual slow manner of the Harvard system) Acting Chief of the Epilepsy Unit and Laboratories (1962-68). He became Chief in 1968. Under his direction a remarkable Division of Neurophysiology was forged with federal and other grant support, combining research and clinical care of the highest quality with an educational mission for physicians, technicians, scientists, and others.

Dr. Lombroso published his first paper on epilepsy in 1950, concerning the electroencephalography and treatment of petit mal epilepsy. One of the first descriptions of subclinical psychomotor epilepsy in children followed. In 1952 he published the first of six papers on the use of acetazolamide for the treatment of epilepsy. He was among the pioneers in the use of carbonic anhydrase inhibitors, a category of agents that has expanded valuably in the past decade. He also participated in the introduction of methsuccimide (1955). His contributions to the use of intravenous diazepam for status epilepticus were of fundamental importance. He introduced the subject almost simultaneously with Gastaut in 1966. Thirteen subsequent papers refined understanding of oral, intravenous and rectal kinetics and dosage, and efficacy in various clinical settings. He was an early proponent of oral and rectal home treatment with diazepam. He was an early advocate of what has become known as “empowerment” of patients, trying to assure the range of their activities was as broad as possible and that they spent as little time as possible in emergency rooms and as inpatients.

Dr. Lombroso’s pioneering concern about what is now called “quality of life” for patients with epilepsy and their families led him to publish papers on the subject of “Living with Epilepsy.” The Family Service Team that he assembled consisted of professionals dedicated to the characterization and amelioration of the cognitive, emotional, social, and economic impact of epilepsy. The unification of various clinical and support services not only rendered the best possible care, it enriched research efforts. It alleviated the possibility that consulting services regarded the expedient care of patients with epilepsy as less urgent than Dr. Lombroso did. It led him, as well, to expand his definition of care of patients with epilepsy to incorporate diseases of other organ systems. Dr. Lombroso followed in Dr. Lennox’ large footprints pursuing the mission to educate not only neurologists and technicians about epilepsy, but also non-neurological physicians, nurses, psychologists, social workers, teachers, and the general public.

To date, Dr. Lombroso has published 176 original papers. In addition to those already considered, particularly noteworthy achievements included his early account with Lennox and Gordon Millichap of childhood cyclic vomiting (1955), the first description of what would become known as benign Rolandic epilepsy (1967), and a classic paper on SSPE (1965). He devoted meticulous attention to epileptic conditions associated with inborn errors of metabolism throughout the ‘60s. With Natalio Fejerman he published the first description of benign myoclonus of infancy (1977). In 1990 he published a classic review concerning the distinction of benign and severe forms of early myoclonic epilepsies. Dozens of important papers concern the diagnosis and treatment of infantile spasms, including the role that focal cortical dysplasia may play as an inciting and remediable influence. With Heni Gascon in 1974 he published a classic consideration of the syndrome of gelastic seizures. With Drs. Mikati, Trevathan, and Krishnamoorthy he wrote a classic account of pyridoxine-dependant epilepsy (1991).

Dr. Lombroso has published three important papers with Guiseppe Erba clarifying the manner in which the sometimes difficult question as to whether electrographic seizures are primary or are the result of secondary generalization may be answered. Erba and Lombroso provided similar clarification with regard to classification of atonic, tonic, and myoclonic seizures, employing prolonged video EEG and EMG. A number of papers provide similarly elegant answers (and questions for further research) concerning the distinction of epilepsy from autonomic dysfunction, movement disorders, and other processes. Particularly lasting contributions were made to reflex syncope, breathholding spells, hyperekplexia, paroxysmal dyskinesias, and nocturnal frontal lobe epilepsy. Elegant papers concerning the classification and prognostic significance of EEG and evoked response patterns of children in coma represent another important area of contribution. Electroencephalographic aspects of Reye syndrome, brain tumors, nephrosis, brain edema, and other conditions are also well-represented in the work of Dr. Lombroso and his colleagues. It is fitting for the grandson of the pioneer in consideration of the “criminal mind” that Dr. Lombroso debunked the prevalent notion that 14 and 6 positive spikes were indicators of criminal tendencies rather than one of a number of normal variants he has characterized (1966).

Dr. Lombroso’s first consideration of neonatal seizures was published with Arthur Rose in 1964. This, along with a paper published the following year established a venerable system of classification that remains in use, as well as detailed consideration of etiologies, management, and outcome. What might best be described as a majestic series of 23 papers followed establishing with extraordinary care most aspects of semiology, EEG changes, differential diagnosis, treatment, and outcome for seizures of premature and fullterm infants. Two classic papers with Greg Holmes in 1993 summarize much of this data. The most recent contribution to this series (2007) provides a 20 year follow-up. It contains, as do so many papers, the assessment of current gaps in understanding and suggestion of future directions for research. Such sustained enthusiasm for the accomplishment of what is yet to be done is the more remarkable considering that this is the perspective of a 90 year old. Many of the papers in this series consider the interactions of brain development and epilepsy including in eight papers the prognostic significance of persistent EEG dysmaturity in the neonatal EEG. It is a noteworthy representation of the keen interest of Dr. Lombroso and his colleagues have had in refinement of bedside diagnosis that he and Giuseppe Erba published, in 1965, two papers on the use of “ultrasonar B-scanning” to map ventricular size in order to better interpret surface EEG findings. The advocacy of this technique prefigured by nearly two decades the better known demonstration by Allan Hill and Joseph Volpe that this method provided a most valuable “window on the brain” of infants.

For more than half a century Dr. Lombroso has attracted trainees from throughout the world, individuals who would carry his methods and program model back to their hospitals of origin. He has trained more than 240 post-graduate fellows, 82% of whom were physicians and 18% PhDs. As the mean training for these individuals has been 1.4 years, this represents 336 years of aggregate effort on behalf of enlarging the cadre of individuals devoted to the study and treatment of epilepsy. Dr. Lombroso’s many distinctions include Presidency of the American EEG Society and the American Epilepsy Society as well as distinguished positions in numerous American and International professional societies. He received the Gold Medal and Special Award in Clinical Neurophysiology from the International League Against Epilepsy, the Herbert Jasper Award of the American Clinical Neurophysiology Society, and the William Lennox Award of the AES.

In 1988 Dr. Lombroso became Chief Emeritus. In 1990 joined his old friends and longterm colleagues Drs. Erba and Burchfiel at Rochester, where he became Adjunct Professor in Neurology. After exerting his usual remarkable energies and expertise in that position for a number of years, he finally “retired” to Boston, though he continued to write and to analyze and publish the results of prior research. He has also maintained an office to see patients in a rather constricted space that included a venerable and indestructible Grass electroencephalograph. This permitted him to combine clinical and electrophysiologic bedside expertise in the care of patients. Dr. Lombroso is of course multilingual – if at times heavily accented – but is equally eloquent in facial expressions and throat clearing that have alerted his trainees to things they may have overlooked and in order to usefully qualify and emphasize his wry sense of humor. His understanding and eloquence extend as well to history, music, art, and literature. His friends have included noteworthy people of letters and famous musicians. Throughout his life he has been a devoted family man. His children include a nurse, a psychologist, and a molecular neuropsychiatrist.