. ,620 LEWELLYS F. BAKKEK 



(laryngospasm, manifest tetany, Chvostek sign) are present, or, if these 

 be absent, tke decisive electrical hyperexcitability of the motor nerves, at 

 least, is demonstrable. Further characteristics of the spasmophilia that 

 he mentions as serving to separate eclampsia from true epilepsy are the 

 seasonal appearance of the attacks, the influence of diet, and the accom- 

 panying rachitis. Spasmophilia is an exquisitely hereditary and familial 

 disease^ which, he believes, stands in relation also to general neuropathic 



inferiority. 



Birk accepted Thiemich's views and enlarged upon them. One of 

 his strongest arguments for separating eclampsia infantum from epilepsy 

 is the ultimate fate of spasmophile children. He reported, in 1907, fifty- 

 three cases in which there had been spasmophilia in early childhood. In 

 none of these had epilepsy developed. They had recurrences of their 

 spasmophile phenomena, it is true, but their attacks were never, he 

 asserted, of epileptic nature; they were characterized by the appearance 

 of Chvostek's sign, and by demonstrable electrical hyperexcitability of 

 the motor nerves. Though epilepsy does not develop from spasmophilia, 

 Birk believed that there is a tendency in these children to an unfavorable 

 prognosis in another direction. Thus, on analyzing his cases, he found 

 that only one third were normal in later life; two thirds of them did 

 badly in school, were intellectually and emotionally inferior, or exhibited 

 pavor nocturnus, headache, and other neuropathic phenomena. That 

 there is no history of epilepsy in spasmophile families is a strong 

 argument, Birk thought, against the identity of spasmophilia and epi- 

 lepsy. 



Another view of the relationships of eclampsia infantum, spasmo- 

 pliilia, and epilepsy is that represented by Potpeschnigg. This author 

 asserted that most eclampsias have nothing to do with Thiemich's spas- 

 mophilia, but their spasms result rather from carbon dioxid poisoning, due 

 to the laryngospasm. Of the eclamptic children he had studied, a number 

 had already become epileptic, and he believed that more would become 

 epileptic later. It is obviously desirable that neurologists and pediatrists 

 should, together, from now on, study these cases of convulsions in chil- 

 dren in order that greater unity of opinion may gradually emerge. 



When epileptic attacks follow tetania parathyropriva after strumec- 

 tomy, there is, Redlich believes, no organic brain lesion ; nor does, in 

 these patients, hereditary or acquired disposition to epilepsy play any 

 special role. In these cases it is the tetany itself that must be the cause 

 of the epileptic attacks. The matter is not quite so clear, Redlich thinks, 

 for the epilepsy that may be associated with other forms of tetany, and 

 the results of further studies must be awaited before the relationships 

 in these groups of cases are satisfactorily explained. That the tetany 

 itself may be responsible in some instances seems probable, but it is also 

 likely that, in others, the association is merely accidental. 



