9C5 



EPILEPSY. 



EPILEPSY. 



908 



The pulse, always difficult to be felt, is commonly quick and small 

 but it becomes distinct towards the end of the paroxysm, and is then 

 more slow and languid. The action of the heart is irregular, tumul- 

 tuous, and loud, and the carotids throb vehemently. After the con- 

 tractions of the muscles hare continued for some time the convulsions 

 diminish in violence, and at length cease altogether. Perspiration 

 breaks out about the head, neck, and breast; the convulsive respiration 

 is followed by sighs, and the spasms of the muscles by subsultus. The 

 patient is now restored to a slight degree of consciousness ; but, as if 

 exhausted by the violence of the struggle, he soon sinks again into a 

 state of profound insensibility, and lies in a deep sleep. During the 

 state of sleep, the perspiration becomes copious and general over the 

 whole body ; the pulse fuller, softer, and slower, and the respiration 

 freer and easier. After a time the person awakes, sometimes suddenly, 

 but in general it is only by degrees that sensation, consciousness, and 

 the power of motion return. Commonly there is no consciousness 

 whatever of anything that has passed during the paroxysm. On 

 coining out of the fit there is generally headache, and always languor. 

 The convulsive stage may last from one or two minutes to fifteen or 

 twenty, and the sleep from one to several hours. The duration of the 

 whole paroxysm is generally from five to ten minutes ; but often two 

 or three attacks follow each other in such rapid succession, that the 

 paroxysm seems to be protracted for several hours. Occasionally death 

 takes place unexpectedly in the midst of the fit, either in consequence 

 of injury inflicted on the brain by congestion of the cerebral blood- 

 vessels, or by the suspension of the respiration through the spasm 

 of the muscles of the larynx, which close the opening of the 

 glottis so completely and for so long a time as to induce the state of 

 asphyxia. 



Such are the general circumstances which accompany an epileptic 

 attack, and the general form of the disease is pretty much the same in 

 all the persons afflicted by it ; the chief difference is in the slightness 

 or severity of the phenomena, in which there is every possible variety, 

 from an attack so severe as to produce instantaneous death to one 

 which is so slight that it can scarcely be perceived. Sometimes, for 

 example, instead of the regular and violent fit just described, the 

 seizure consists merely of loss of consciousness, slight rigidity, spasms 

 or convulsions of a few muscles or of a single liinb, the attack lasting 

 i .illy a minute or two. At other times the patient is seized with sick- 

 ness or a sensation of faintness, the sight becomes dim, the recollection 

 imperfect, and the power of voluntary motion so far impaired, that the 

 person slips from his chair, or falls from his horse, and lies on the 

 ground insensible, pale, perspiring, but without convtdsions. Or the 

 attack may be so slight that consciousness is not wholly lost ; but the 

 mind becomes confused, the power of articulation suddenly diminished, 

 and instead of finishing the sentence he was uttering, the person con- 

 tinues to mumble for half a minute or a minute the last words he was 

 attempting to speak, in a slow, monotonous, gibbering manner ; and 

 then recovering, he takes up the thread of his discourse, being soon 

 aware of an interruption of consciousness, which interruption there is 

 often an effort to conceal. This state is described by the persons 

 subject to it as one of great mental distress and depression, like a 

 frightful dream : they feel perplexed and afflicted by an imperfect 

 reminiscence of some overwhelming calamity, or a sense of remorse for 

 which they cannot assign a cause. A paroxysm of this kind is like a 

 short mood of extreme melancholy, and such is the impression that the 

 countenance of the patient, which is full of sadness, makes upon the 

 spectator. These slighter paroxysms may recur only at very distant 

 intervals ; hut they more commonly return often, and sometimes three 

 or four times a day. 



The return of the regular epileptic paroxysm is exceedingly various 

 in different individuals. Several years may intervene between the 

 f'i/uren; or they may recur once every month, week, or day. It is 

 stated that they sometimes recur periodically, and with remarkable 

 exactness to the very day ; once a year, or once a month. When they 

 recur monthly, and observe a stated day, that day sometimes coincides 

 with the new or full moon, a coincidence to which great importance 

 was attached in former times. The interval of a lunar month is more 

 commonly noticed among females, from the connexion of the disease 

 with the uterine functions. In some instances, the paroxysms occur 

 every week, on the same day ; and occasionally every day, or night, at 

 the same hour ; but they most frequently come on when first falling 

 asleep, and are often for a time unsuspected or overlooked. Sometimes 

 several slight seizures take place in one day ; but then* recurrence is 

 often extremely irregular. When they are neglected, they usually 

 either become more and more severe, or occur after shorter intervals, 

 lousnem and sensation being abolished, pain cannot be felt 

 during the fit. 



Though the epileptic attack usually comes on suddenly, yet it some- 

 times give* dixtinct warning of its approach. The symptoms 

 premonitory of an epileptic fit are analogous to those which precede 

 an attack of apoplexy [APOPLEXY], namely, headache, giddiness, 

 flushing of the face, throbbing of the temples, drowsiness, sense of 

 weight or heaviness of the head ; flashes of light before the eyes, 

 sleeplessness, fretfulness, irritability, or unusual cheerfulness and 

 hilarity ; disorders of the digestive organs, as voracious appetite, sick- 

 new, vomiting, constipation, or diarrhoea. But there is one peculiar 

 sensation, termed the aura epikptica, of which many epileptics are 



conscious immediately before the fit. This consists of a feeling as if 

 something were moving in some part of the limbs, or trunk of the 

 body, and creeping thence upwards towards the head. Sometimes it 

 is described as a sensation of a current of air, a stream of water, or a 

 slight convulsive tremor ; at other times no distinct idea can be given 

 of the feeling further than that it is a sensation of something moving 

 along. This remarkable sensation does not appear to follow very 

 distinctly the course of a nerve, but it seems to pass along the integu- 

 ments. When it reaches the head, the patient is instantaneously 

 deprived of sense, and falls down in convulsions. The sensation arises 

 in different parts of the body, in the toe, foot, leg, and groin ; in the 

 finger, hand, and arm ; at the bottom of the spine ; in the uterus, loins, 

 abdomen, and chest. But, in the great majority of cases, the attack of 

 epilepsy is preceded by no such warning; and even where the 

 premonitory symptoms do exist, the attack does not by any means 

 always follow. 



Epilepsy rarely occurs in a person otherwise ill sound health. Out 

 of three hundred cases, the early history of each of which was 

 carefully investigated, very few had been perfectly well previously to 

 the accession of the disease. Convulsions during the first dentition, 

 eruptions on the skin, mental excitement, diseases of the glands, 

 chorea, hysteria, tremor, cramp, vertigo, palpitation, headache, flushing, 

 bleeding from the nose, precede the first epileptic attack, and perhaps 

 may be considered, at least in part, as predisposing causes of the 

 malady. 



As this disease is often long preceded by other maladies before the 

 actual seizure, so, after it has subsisted for some time, it induces a 

 peculiar state of the constitution, and more especially, it would appear, 

 in the nervous system, which predisposes to the recurrence of the 

 attack, and the signs of which internal state are manifest in a peculiar 

 expression of the external features. The eyelids become swollen : the 

 eyes prominent and unsteady ; the look vacant ; the cheeks pale, the 

 lips thick ; and the individual features, however originally beautiful, 

 grow coarse, and lose their fine expression. The steadiness and energy 

 of the mind progressively diminish ; the purpose becomes irresolute, 

 and the power of continuous application for the accomplishment of a 

 given object is lost. Instances are recorded in which, though the 

 disease recurred frequently for a long series of years, neither the 

 memory nor any other mental faculty appeared to be impaired ; but 

 this is exceedingly rare. 



"Of 298 epileptics in the Salpetriere, in 1813, 89 were maniacal, 

 and 56 in various states of mental alienation and imbecility. In 1822, 

 out of 339 cases in the same hospital there were 2 monomaniacs, 30 

 maniacs, 34 furious maniacs, 129 insane for some time after the 

 paroxysms, 16 constantly insane, 8 idiotic, 50 upon the whole reason- 

 able, but with impaired memories, and liable to occasional slight 

 delirium and tendency to insanity, and 60 without aberration of 

 intellect, but! irascible, capricious, obstinate, and presenting something 

 singular in their characters." A very common termination of epilepsy 

 is apoplexy or paralysis. 



Authors commonly divide epilepsy into two species : first, idio- 

 pathic, where the disease depends on some primary affection of the 

 brain, and, secondly, sympathic, in which it depends on an affection 

 of some remote part, as the stomach, the liver, the bowels, the gene- 

 rative organs, the circulating system, &c. 



The state of the brain on which epilepsy depends is unknown. 

 Dissection shows that the brain of the epileptic is seldom sound ; but 

 much as this subject has been investigated, little light has hitherto 

 been shed upon the pathology of the brain as connected with this 

 disease. The most common morbid appearance are the thickening of 

 the bones of the skull ; spiculoe or morbid growths of the bone from 

 the inner table of the skull ; vascular turgescence, or inflammation of 

 the membranes of the brain ; preternatural hardness or softening of 

 the substance of the brain and of the spinal cord ; effusions of serum, 

 blood, jelly, or pus between the membranes, xipon the surface or into 

 the ventricles of the brain ; tumors or morbid growths in its sub- 

 stance ; adventitious deposits, as tubercles, or parasitic animals, as 

 hydatids. Recent researches appear to indicate that the parts of the 

 brain which most commonly undergo morbid changes of structure in 

 this disease are the parts more immediately in the neighbourhood of 

 the sphenoid bone, and especially the pineal and the pituitary glands, 

 and particularly the latter. But occasionally, where violent epilepsy 

 has existed during life, the most careful examination of the brain after 

 death has led to the discovery of no appreciable chauge in its 

 structure ; while even the morbid appearances which are manifest are 

 often observed to be prcbent without being accompanied with epilepsy ; 

 so that the relation between any known morbid change in the struc- 

 ture of the brain and epilepsy is not yet certainly established. It 

 follows, as has been stated, that nothing is really known of that 

 condition of the brain which causes epilepsy. 



But many of the causes of the malady are well ascertained, and the 

 knowledge of these is of great importance in the prevention and cure 

 of the disease. It is conceived that there is a constitutional predispo- 

 sition to epilepsy, although it does not seem easy to assign with exact- 

 ness in what this predisposition consists. Several of the exciting causes 

 are weak impressions which are applied to most persons with little or 

 no effect. 



The exciting causes consist of two classes, those which act by 



