by Peter Wolf
On December 25, 2016, the international epileptological community has lost one of our iconic figures when Prof. Dieter Janz passed away, 96 years old. His contributions to our field are numerous and manifold.
He started his career as a neurologist in 1946 in Heidelberg University Hospital where he soon became interested in epilepsy. This field at the time looked still rather amorphous and he attempted to structure it better by identifying syndromatic entities. An EEG was not yet available so he based his early delineations entirely on clinical and biological criteria such as age relations, biorhythms, motor seizure patterns, combinations of seizure types, psychological traits and behavior, or response to environmental stimuli. With the focus on generalized tonic-clonic seizures, sleep epilepsies and awakening epilepsies seemed to stand out as distinct complex conditions. But the full strength of this comprehensive clinical approach became apparent with the description, in 1957, of the syndrome for which he proposed the name "Impulsive Petit Mal" and which now is known as Juvenile Myoclonic Epilepsy or, eponymously, Janz syndrome. Myoclonic jerks which up to then had been largely ignored became the syndrome's core feature, and the description even encompassed peculiar personality traits that half a century later became understood as indicators of subtle frontal lobe dysfunction.
In the same period, Dieter Janz was one of the first to question the rather irrational treatment habits of the time where virtually everybody received fixed combinations. In Heidelberg, monotherapy first, if necessary in the highest tolerated dose, became the treatment standard.
In 1969 appeared the monograph "Die Epilepsien. Spezielle Pathologie und Therapie", where Janz sums up the earlier literature and more than 20 years of clinical experience and analysis. This book represents the probably last attempt, before the later multinational and multidisciplinary explosion of epilepsy research, of a single author to cover the entire field of epilepsy. Incredibly rich in subtle, precisely described clinical observations and their scientific interpretation this is one of the masterworks of epileptology of the 20th century, a good reason to learn German to read it. His next project following the book was a large prospective long-term clinical and EEG investigation of the offspring of the patients under his care. It became one of the kick-offs for the development of modern epilepsy genetics. When the ILAE in 1985 established a Commission on Genetics, Janz became its Chair for the subsequent 8 years.
The genetic project had started in Heidelberg but continued in Berlin where, in 1973, Janz became Professor of Neurology at the Klinikum Chalottenburg of the Free University Berlin. Here he became a greatly estimated teacher for graduates and post-graduates, not the least because he represented the Victor von Weizsäcker - founded Heidelberg school of anthropological medicine, which attempts a comprehensive understanding of illness in its psycho-physical and social dimensions. This approach appealed to a young generation who was skeptical about views of medicine as a merely biological discipline. This did not prevent the Berlin department from engaging in the newest developments of the period, i.e. antiepileptic drug monitoring and video-EEG diagnostics where it soon gained international reputation. In consequence, Dieter Janz was elected ILAE Vice President, an office he held from 1973 – 1981.
In addition to his clinical and research commitments, Janz was always deeply involved in initiatives to improve on all levels the conditions for epilepsy and those affected by it. He was highly instrumental in the establishment, in 1957, of a German Chapter of the ILAE, at present the German Society for Epileptology. His starting a specialized seizure clinic at Heidelberg University Hospital became the first step of the development of a countrywide network of epilepsy clinics. These became a highly important instrument for the improvement of epilepsy care in Germany. In Berlin, he helped to establish the first epilepsy self-help group in Germany.
In his health care initiatives, he was greatly supported by the Michael Foundation, which had been established in 1962 by Dr. Fritz Harzendorf, the father of one of his patients. With Dieter Janz as its mentor, the Foundation rapidly became an instrument for innovative initiatives, including sponsorship for specialization in epilepsy for doctors and allied professionals, and start-up aids for seizure clinics and the self-help movement. They took the lead for the establishment of a German Epilepsy Information Center and the appointment of an expert panel to monitor the situation of epilepsy in Germany and publish national reports. One of his first proposals to the Foundation was the establishment of the Michael Prize for the best research, which has developed into one of the most important international awards in our field. The Michael Foundation has over the years developed into the favorite child of Dieter Janz. Apart from international discussion forums with the Michael Prize winners, he particularly enjoyed the Foundation's annual epilepsy seminars in Gargnano on Lake Garda in Italy, which he never missed since their start in 1988, and where still in recent years he contributed lectures of great wisdom.
As professor emeritus, he remained active in research and as a mentor for postgraduates. His interest moved increasingly to philosophical matters and, in particular, anthropological medicine. He became one of the founders of the Viktor v. Weizsäcker Society and co-editor of v. Weizsäcker's Collected Works. In his last years, he was working intensely on the edition of the latter's correspondence.
Dieter Janz received many distinctions including the Ambassador for Epilepsy (1969), the Michael Prize (1969), the Lifetime Achievement Award of ILAE and IBE (1999) and the Otfrid Foerster Medal (2004). He was Honorary Member of the German Society for Epileptology, the Michael Foundation Board of Trustees and the Viktor v. Weizsäcker Society, and honorary and corresponding member of several international societies.
He will greatly be missed for his inspiring critique, his philosophical mind, and his comprehensive clinical understanding.
(Peter Wolf, Copenhagen and Florianópolis)