618 



LEWELLYS F. BARKEE 



both the result of a toxic process affecting the central nervous system. 

 In two casdb that came under his own observation, lesions (cysts) were 

 found in the hypophysis cerebri, and he thinks the psychoses in these two 

 instances may have been related to the hypophyseal disease. 



8. Tetany and Epilepsy 



A collective review of the whole literature on the relationships of 

 tetany and epilepsy was published, in 1911, by Emil Redlich of Vienna, 

 in the Monatssclirift fur Psychiatrie und Neurologic. Redlich had, him- 

 self, observed eleven patients in whom tetany and epilepsy (or at least 

 epileptiform attacks) had occurred together. This experience led him to 

 study the cases reported since 1891, when this combination had first been 

 observed. He found altogether, in addition to his own case, forty-six 

 definite instances reported in the literature, and also twenty-six cases 

 that had been less well described, that is some seventy-two cases in all. 



Redlich divided the cases of combined tetany and epilepsy into 

 groups: (1) patients who have had typical epilepsy for years, or those 

 who earlier have had at least one attack of epilepsy, and who, later, have 

 exhibited temporary, often recurring, phenomena of tetany; and (2) cases 

 of tetany in which, during the course of the tetany, or simultaneous with 

 its onset, epileptic attacks have set in. 



In the first group of cases, the epilepsy and the tetany need not neces- 

 sarily stand in etiological relationship, whereas, in the second group, an 

 etiological-patliogenetic connection is more probable. Of the second group, 

 twenty-one were cases of tetania parathyropriva following strumectomy, 

 seventeen were cases of juvenile idiopathic tetany (epidemic-endemic 

 form), five were cases of maternity tetany, and the others were cases of 

 epilepsy in infantile tetany and in gastric tetany. 



It is interesting that fifteen out of the seventeen patients with epilepsy 

 in tetania parathyropriva after strumectomy were women; only two 

 were men ; whereas, among sixteen examples, of epilepsy in epidemic- 

 endemic tetany, eleven were in men and five were in women. As is well 

 known, men are much more often affected by idiopathic tetany than are 

 women. 



Certain peculiarities of the tetany and of the epileptic attacks were 

 noticeable in the idiopathic tetany group. Thus, in one case, the tetany 

 attacks remained for years limited to the right side; in another, the 

 epileptic attacks began by the assumption of the tetany position in the 

 left upper extremity; in still another case, the epileptic attacks were 

 preceded for hours by tetany spasms. In a case observed by Luger 

 epileptic attacks appeared when testing for the leg phenomenon. After 

 the epileptic attacks the Erb phenomenon and the Trousseau phenomenon 



