Epilepsy

“ From reading those and other works I know that epileptic convulsions sufficiently violent to cause death frequently occur without the patient entirely losing his consciousness. Epilepsy, properly so called, is sudden in its attack. The patient falls down at once with a shriek. That disease occurs very often at night, and in bed. It sometimes happens that its existence is known to a young man’s family without his knowing anything about it. Convulsions of an epileptic character are sometimes preceded by premonitory symptoms. ”

“ I hope to show that the main roots of the so-called epileptic alteration in general necessarily lie in the primary make-up of such individuals, and that the seizure phenomena of epilepsy only intensify and make more marked the fundamental make-up when the disease has definitely fastened itself upon the individual. ”

“ Epilepsy affects between 1 and 2 percent of the U.S. population. Of people who have epilepsy, two-thirds appear to have no structural abnormality of the brain; in the remaining third, the disease can be traced to brain damage at birth, a severe head injury, an infection that caused brain damage, or a brain tumor.
The emotional symptoms of epilepsy can involve either anxiety or depression or both. Once a person has had a convulsive seizure, he or she may live in constant apprehension that another seizure will occur. There may be occasional, transient feelings of unreality. ”

“ When we find paroxysmal attacks occurring in individuals with atypical heads, thick swollen lips, scarred tongues, and irregular teeth, we may strongly suspect the patient to be epileptic. To these we may add the appearance of the eyes, the fishy, lack-lustre expression which betokens old epilepsy. The hands are clammy and the skin mud-colored; the hair is dry and coarse; and the body often has a death-like odor. ”

“ I never knew a case in which during the paroxysm the patient spoke. Epilepsy is sometimes attended with opisthotonos. I have seen cases of traumatic tetanus. In such cases the patient retains his consciousness. I have known many cases of epilepsy ending in death. Loss of consciousness—not universally, but generally—accompanies epilepsy. I never knew a case of death from that disease where consciousness was not destroyed. I have known ten or twelve such fatal cases.
Re-examined by Mr. Grove: Persons almost invariably fall asleep after an epileptic attack. ”

“ To sum up, epilepsy is a chronic abnormality of the higher nervous system, characterized by periodic attacks of alteration of consciousness, often accompanied by spasms of varying violence, affecting primarily the brain and secondarily the body, based on an abnormal readiness for action of the motor cells, occurring in persons with congenital nerve weakness, and leading to mental decay of various types and degrees of severity. ”

“ Let us turn from insanity to grave nervous disease. Epilepsy at once comes before us, all the more significantly since it has been considered, more especially by Lombroso, to be the special disease through which genius peculiarly manifests itself. It is true that much importance here is attached to those minor forms of epilepsy which involve no gross and obvious convulsive fit. The existence of these minor attacks is, in the case of men of genius, usually difficult to disprove and equally difficult to prove. ”

“ Quivering, spasmodic movements of the eyelids are often seen; but the eyes are not fixed and turned upward with dilated pupils, as in epilepsy. The patient does not usually hurt herself in these purposive attacks. She may or may not appear to be unconscious. She does not bite her tongue, nor does she foam, as does the true epileptic, although she may spit and sputter in a way which looks somewhat like the foaming of epilepsy. She comes out of the fit often with evident signs of exhaustion and a tendency to sleep, but does not sink into the deep stupor of the post-paroxysmal epileptic state. ”

“ At times even so simple a condition as migraine so nearly simulates epilepsy of the psychical type, because of its complications and sequelae and the regularity with which it occurs, that it has been spoken of as an epileptic equivalent. There is no doubt that, in successive generations, epilepsy and migraine may have a relation to one another that is something more than merely a coincidence. ”

“ For example, one of those who had no attacks during treatment was a woman who had been afflicted with epilepsy for eighteen years, of a severe form, with general convulsions, biting tongue, etc. Another was a very delicate, nervous woman, who suffered, in addition to the seizures, from pulmonary and laryngeal phthisis, who came of a family impregnated with epilepsy, and whose intellect was greatly impaired. By far the largest class are those benefited by treatment, and these comprehend every species of case, chronic and recent, complicated, inherited, in the old and young, and so on ”

“ In this table we observe very singular results in the treatment of this remarkable disease. In most ailments, the longer they have existed and the more chronic they are, the more difficult and imperfect is the prospect of recovery. This does not appear to hold good in the case of epilepsy. For when we analyze the above table we find that the results, on an average, are as satisfactory in those cases in which the disease has existed over ten years as in those which began less [Pg 32] than one year before the patient came under observation. ”

“ According to them, epilepsy is a disease characterized by a lack of the natural instinctive interest in the environment which is expressed chronically in the deterioration, and episodically in the attacks, the most consistent feature of which is loss of consciousness. ”

“ Handfield Jones [7] “eccentric causes.” As “centric causes,” he names “poisoning of the blood from retention of excrementitious matter; this, by deranging the nutrition of the nervous tissue, generates the abnormal excitability, which then manifests itself without any special irritant. Various causes of exhaustion, such as hæmorrhage and excessive discharges, venereal excesses, prolonged want of sleep, unremitting pain,” &c., are all “centric” causes of epilepsy. ”

“ In epilepsy the patient always loses consciousness. Apoplexy never produces tetanic convulsions. Perhaps I might be allowed to say that when there is effusion of blood upon the brain, and a portion of the brain is involved, the muscles may be thrown into short tetanic convulsions. In such case the consciousness would be destroyed. Having heard described the symptoms attending the death of the deceased, and the post-mortem examination, I am of opinion that in this case there was neither apoplexy nor epilepsy. ”

“ The trouble for which this young man sought relief was, to all appearance, purely physical. It consisted of periodic convulsive attacks that racked the right half of his body, and had led to a diagnosis of epilepsy. Since sundry delicate symptoms characteristic of epilepsy were absent, however, the specialists, after a careful study of the case, came to the conclusion that the spasms from which their patient suffered might involve no true organic disease, and might be nothing more than the outward manifestation of some deep-seated psychical disturbance. ”

“ Epilepsy is such a chronic disease, and seems to me to produce not only weakening of the mind, but to cause it to be often entirely lost, that, although we may get, as in the following case, a temporary re-kindling of the mental energies, I fear we are not yet able to give much hope of complete recovery. ”

“ Friends of epileptics know very well that it is a preliminary symptom of the coming on of an attack of epilepsy for the patients to become even more irritable than usual. Just after the comatose condition which follows an attack of epilepsy patients are also prone to be very irritable. An attack of epilepsy is really an explosion of nerve force, for no rational purpose, along motor nerves. This same tendency to an unwarranted explosion of energy is liable to occur along other nerve tracts that rule the patient's disposition. ”

“ Epileptic convulsions are not attended with the fear of death, as in the hysteric disease, and the urine is of a straw colour. However it must be noted, that the disagreeable sensations in hysteric diseases sometimes are the cause of true epileptic convulsions, of syncope, and of madness.
The pain, which occasions some fits of epilepsy, is felt for a time in a distant part of the system, as in a toe or heel; and is said by the patient gradually to ascend to the head, before the general convulsions commence. ”

“ Our better knowledge of epilepsy, however, should gradually take the disease out of the sphere of suspected mystery in which it has been popularly placed and set it among the diseases to which human nature is liable, but which is surely as physical in its character as any other. ”

“ The convulsions of epilepsy are accompanied by a variety of symptoms. When a patient dies of epilepsy he dies perfectly unconscious and comatose. I never saw any case of convulsive disease at all like this. There are cases of convulsive disease which are similar to tetanus in their onset, but not in their progress. For example, laceration of the brain, a sudden injury to the spinal cord, and the irritation from teething in infants, will produce convulsions resulting in death ”

“ Medical Age. Every physician who would get at the gist of all that is worth knowing on epilepsy, and who would avoid useless research among the mass of literary nonsense which pervades all medical libraries, should get this work." The Sanitarian. It contains all that is known of the pathology of this strange disorder, a clear discussion of the diagnosis from allied, neuroses, and the very latest therapeutic measures for relief. It is remarkable for its clearness, brevity, and beauty of style. ”

“ Doctor Wilmarth says, “Epilepsy and mental deficiency are as closely related as branches on the same tree.... Over one-half and perhaps two-thirds of all feeble-minded are subject to convulsive seizures at some period of their lives, and we are never surprised at the appearance of epilepsy in any feeble-minded person. On the other hand, so small a percentage of epileptics maintain normal mental actions as hardly to be worth consideration ... even those who retain a normal mind in the early stages of the diseases almost infallibly become imperfect later.” ”

“ The ordinary hysterical attack is never attended by loss of consciousness, by any of the pupillary changes so constant in epilepsy, by the mobility of the pupil between the attacks which is present in a large number of true epileptic individuals. There are never the succeeding changes of color, and the seizures are commonly produced or attended by some emotional disturbance, or are associated with ovarian disturbance. ”

“ Epilepsy.—Epileptic attacks are a very common symptom of meningeal syphilis, and are of great diagnostic value. The occurrence in an adult of an epileptic attack or of an apoplectic fit, or of a hemiplegia after a history of intense and protracted headache, should always excite grave suspicion. ”

“ Recovery.—The authority above goes on to say: "This may be given today in the words of Hippocrates: 'The prognosis in epilepsy is unfavorable when the disease is congenital (that is, existing at birth) , when it endures to manhood, and when it occurs in a grown person without any previous cause. The cure may be attempted in young persons but not in old.' '' Death rarely occurs during the fit, but it may happen if the patient is eating. If the attacks are frequent and the patient has marked mental disturbance the conditions are unfavorable. Males have a better outlook than females. ”

“ Is epilepsy a functional neurosis or an organic disease? Analogy suggests organic changes. No such changes have been constantly demonstrated by post mortem evidence; partly, of course, because post mortem examinations of cases of death in the epileptic or epileptiform condition have been extremely rare, and are not very common in cases where there is a well-authenticated history of attacks; but partly because our investigations into the minute anatomy of many morbid conditions are at present barred by the limitations of microscopic vision. ”

“ So also does it appear that a relatively small and localized nerve explosion is capable, under conditions which we do not at all understand, of propagating itself irregularly through the nervous system, ignoring the usual association paths, until the entire nervous mechanism is exhausted. Such a progressive, periodic disturbance is said to be epileptiform. The causes of the various forms of epilepsy are often unknown. ”

“ Of the former 63.4 per cent. had relatives afflicted with epilepsy, and 12.1 per cent. with insanity. Epilepsy, according to these figures is eminently a hereditary disease, and it is possible even to a greater extent than is here represented; for the family history is often very difficult to arrive at, in the class of persons on whom most of these observations were made, who, either from ignorance or from prejudice, display a great want of knowledge concerning the health of their ancestors. ”

“ Epileptiform Seizures are convulsions due to causes other than epilepsy, and only a doctor can tell if an attack be epileptic or not and prescribe appropriate treatment. To give "patent" medicines for "fits", to a man who may be suffering from lead poisoning or heart disease, is criminal.
Convulsions in Children often occur before or after some other ailment. Such children need careful training, but less than 10 per cent of children who have convulsions become epileptic. Epilepsy should only be suspected if the first attack occurs in a previously healthy child of over two years of age. ”