EPILEPTIC FIT. Three well-marked varieties of the epilep tic seizure are known, le grand mal, le petit mal and Jacksonian epilepsy. Any may exist alone, but the two former may occur to gether. The first is generally known as an epileptic fit.
Although in most instances an attack comes on suddenly, it is in many cases preceded by certain indications or warnings. These are very varied and may be in the form of some temporary change in the disposition, such as unusual depression or elevation of spirits, or of some alteration in the look. Besides these general symptoms, peculiar sensations often immediately precede the onset of the fit (aura epileptica). The aura may be mental e.g., an agonizing feeling of momentary duration; sensorial e.g., pain in a limb or in some internal organ, or may concern the special senses; or, motorial e.g., contractions or trembling in some of the muscles. When such sensations affect a limb, the employment of firm compression by the hand or by a ligature occasionally suc ceeds in warding off an attack. The aura may be so distinct and of such duration as to enable the patient to lie down, or seek a place of safety before the fit comes on.
The seizure is usually preceded by a loud scream or cry, not due to terror or pain, but to the convulsive action of the muscles of the larynx, and expulsion of a column of air through the nar rowed glottis. If the patient is standing he immediately falls, and often sustains serious injury. Unconsciousness is complete, and the muscles generally are in a state of stiffness or tonic contrac tion, mainly affecting one side of the body. The head is jerked towards one or other shoulder, the breathing is for the moment arrested, the countenance first pale then livid, the pupils dilated and the pulse rapid. This, the first stage of the fit, generally lasts for about half a minute, and is followed by the state of clonic (i.e., tumultuous) spasm of the muscles, in which the whole body is thrown into violent agitation, occasionally so great that bones are fractured or dislocated. The eyes roll wildly, the teeth are gnashed together, and the tongue and cheeks are often severely bitten. The breathing is noisy and laborious, and foam (often tinged with blood) issues from the mouth, while the contents of the bowels and bladder are ejected. This stage lasts from a few seconds to several minutes, when the convulsive movements gradually subside, and relaxation of the muscles takes place, to gether with partial return of consciousness, the patient looking confusedly about him and attempting to speak. This, however, is soon followed by drowsiness and stupor, which may continue for several hours, when he awakes either apparently quite recovered or fatigued and depressed, and occasionally in a state of excite ment which sometimes assumes the form of mania.
Epileptic fits of this sort succeed each other with varying de grees of frequency, and occasionally, though not frequently, with regular periodicity. In some persons they only occur once in a lifetime, or once in the course of many years, while in others they return every week or two, or even are of daily occurrence, and occasionally there are numerous attacks each day. When the fit returns it is not uncommon for one seizure to be followed by another within a few hours or days. Occasionally there occurs a constant succession of attacks extending over many hours, and with such rapidity that the patient appears as if he had never come out of the one fit. The term status epilepticus is applied to this condition, which is sometimes fatal. In many epileptics the fits occur by night as well as by day, but in some instances they are entirely nocturnal, and then the disease may long remain unrecognized.
The second manifestation of epilepsy (le petit mal), differs from that above described in the absence of the convulsive spasms. It consists essentially in a sudden, short arrest of volition and con sciousness, and may be accompanied with staggering or some alteration in position or motion, or simply exhibit itself in a look of absence or confusion, and should the patient happen to be engaged in conversation, by an abrupt termination of the act. In general it lasts but a few seconds, and the individual resumes his occupation without perhaps being aware of anything having been the matter. In some instances there is a degree of spasmodic action in certain muscles which may cause the patient to make some unexpected movement, such as turning half round, or walk ing abruptly aside, or may show itself by some unusual expression of countenance, such as squinting or grinning. There may be some aura preceding such attacks, and also faintness following them.
The third manifestation—Jacksonian epilepsy or partial epi lepsy—is distinguished by the fact that consciousness is retained or lost late. The patient is conscious throughout, and is able to watch the march of the spasm. The attacks are usually the result of lesions in the motor area of the brain e.g., cerebral tumour or depressed fracture of skull.
Epilepsy appears to exert no necessarily injurious effect upon the general health, and is quite consistent with great bodily vigour. It is very different, however, with regard to its influence upon the mind. Allusion has already been made to the occasional occur rence of maniacal excitement as one of the results of the epileptic seizure. Such attacks (epileptic insanity) are generally accom panied by dangerous and violent acts and appear to be more frequently associated with the milder form of epilepsy where they either replace or immediately follow the short period of uncon sciousness. The subject is one of the greatest medico-legal interest and importance in regard to criminal responsibility.