CHAPTER XIV 



The physiopathology of epileptic seizures 



HENRI GAS TAUT I Favulte de Medecine, Marseille, France 

 M. F I S C H E R - W I L L I A M S j London Hospital, London, England 



CHAPTER CONTENTS 



Symptomatology 



Types of Generalized Epilepsy 

 Grand mal 



Petit mal of absence' type 

 Petit mal of myoclonic type 

 Types of Partial Epilepsy 

 Clinical aspects 



Electroencephalographic aspects 

 Etiology 



Functional Epilepsy 

 Organic Epilepsy 

 Physiopathology of Seizures Generalized from Start 

 Experimental Results 

 Grand mal 



Theories of generalized convulsions 



Mechanism of bioelectric discharges in generalized epilepsy 

 Petit mal of myoclonic type 

 Petit mal of 'absence' type 

 Interpretation of Experimental Results 



Origin, nature and propagation of nervous acti\ity respon- 

 sible for generalized grand mal seizure 

 Causes of reticular discharges, thalamic and niesenceph- 

 alorhombencephalic, responsible for grand mal epilepsy 

 Duration and termination of discharge in generalized 



epilepsy 

 Myoclonus of petit mal 

 Petit mal 'absence' 

 Physiopathology of Partial Epilepsies 

 Experimental Results 



Experimental partial epilepsy of cortical origin 

 Experimental partial epilepsy of rhinencephalic origin 

 Experimental partial epilepsy of subcortical origin 

 Experimental partial epilepsy, secondarily generalized 

 Experimental partial epilepsy with erratic discharges 

 Anatomicals Studies 

 Physiopathogenesis of Partial Epilepsies 



Origin and cause of neuronal discharge in partial epilepsy 

 Propagation and termination of neuronal discharge in 



partial epilepsy 

 Distinction between two great varieties of partial epilepsy 

 with respect to character of their discharges 



BECAUSE OF THE IMPORTANT mcdical application 

 of this chapter, it seems useful to preface it with a 

 short summary of the clinical and electroenceph- 

 alographic events accompanying epileptic seizures 

 in man. 



SYMPTOMATOLOGY 



There are two types of epilepsy, from both the 

 clinical and the electroencephalographic point of 

 view: a) generalized epilepsy, in which the clinical 

 manifestations involve the entire individual and the 

 EEG discharges can be recorded all over the scalp; 

 and 6) partial epilepsy, in which only a part of the 

 individual is involved clinically and the electrical 

 disturbance can be recorded from a part of the scalp 

 only. 



Types oj Generalized Epilepsy 



It is clear that the different types of generalized 

 epilepsy arc similar in their electrical and clinical 

 manifestations; they constitute a remarkably homoge- 

 neous group in symptomatology. From the clinical 

 point of view, the two important features which they 

 have in common are loss of consciousness and con- 

 vulsions involving the whole skeletal musculature to 

 a greater or lesser extent. These phenomena are so 

 spectacular that the other manifestations, notably 

 those in the autonomic sphere, are relegated to .second 

 place. From the EEG point of view, their common 

 manifestation is a seizure discharge of conxulsive 

 waves which are bilateral, synchronous, symmetrical 

 and generalized over the scalp. The following three 

 varieties of generalized epilepsy are distinguished 



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