LEWIS H. ADLER, JR., Philadelphia.
EPILEPSY.—From knf7.ayi3civEtv, to fall upon or seize.
Synonyms. — Morbus sacer; falling sickness.
Definition.—Epilepsy may be defined as a disease characterized by the habit of having convulsions, attended usually with unconsciousness, the seizures occur ring suddenly and at irregular intervals, the subject showing an essential tend ency to progressive mental and motor weakness.
Varieties.—The generic term epilepsy is applicable to and includes numerous subtypes, some of which differ from each other symptomatically and otherwise most markedly; hence the necessity for a classification of varieties. We have, for example, a division into two forms ex pressive of a difference in the degree and intensity of the motor spasm and impair ment of consciousness in the attack— major and minor epilepsy, or, as the French express it, grand and petit mal. Other synonyms are general and partial, and, in a more restricted sense, frank or masked epilepsy. In grand mal both consciousness and motor spasm are in volved in profound degrees. In petit ma) both consciousness and motor spasm may be only slightly and transiently involved. In general epilepsy the motor spasm may involve all the muscles of the body and the loss of consciousness may be absolute. In partial epilepsy only one extremity or even one set of muscles may be affected and consciousness only slightly if at all perceptibly impaired.
The distinction between partial (Jack sonian) and true epilepsy is not a sharp one. The partial may end in general convulsions, with loss of consciousness; on the other hand, chronic convulsions in true epilepsy may occasionally be limited to a certain part of the body, and not be with unconsciousness. H. Hider (Neurol. Centralb.. No. 4, '97).
Partial epilepsy is, perhaps, more readily recognizable under the name Jacksonian, or cortical, epilepsy: terms more popular, since they embody facts of etiological and pathogenic, as well as symptomatic, significance. The term "cortical" is, however, utterly inde fensible here, since we have good reason to believe that all epilepsies are essen tially of cortical origin. In masked epilepsy there may be neither motor spasm or apparent unconsciousness, but certain phenomena of abrupt onset in the psychical or motor volitional sphere may occur which, by reason of their habitual recurrence in the same or simi lar form, constitute a variety of the dis ease; automatic, causeless, but appar ently purposive movements may repre sent the entire motor explosion. A tran sient stupidity or absence of mind—per haps a random or irrelevant remark— may be the only evidence of impaired consciousness. Certain vasomotor dis
turbances, such as pallor, flushing, etc., usually accompany attacks of this char acter. In certain cases, first described by Weiss and to which he gave the name "psychical" epileptics, the explosion is, objectively at least, entirely in the direc tion of disturbed mental equilibrium, such patients being subject to irregularly and abruptly recurring paroxysms of transient insanity, usually with an aura, or warning, and with no recollection sub sequently of the attacks. Such seizures, as well as other less marked, but irregu larly recurring psychical disturbances, are described by other writers as epilep tic psychical equivalents.
The element of periodicity in the time of occurrence of the attack, a factor of some importance in both prognosis and treatment, has served as the basis for a chronological division into diurnal, or day, and nocturnal, or night, epilepsy, the former being still further divisible into the matutinal, or morning, and the vesperal, or evening, cases. In the suc ceeding paragraphs upon symptoms we shall find evidence of the necessity for a further elaboration of subtypes.
symptom-picture in epilepsy varies quite widely, as has been intimated in the classification and de scription of subtypes. Not only is there a marked difference symptomatically in these clinical subvarieties, but each in dividual patient may differ in some major or minor particular from all others, although preserving in each in stance some essential factor revealing a common identity. In typical grand mal the patient, with or without an aura, or warning, is suddenly seized with a con vulsion, attended with unconsciousness of greater or less degree. There is simul taneously a sudden alteration in color, either lividity or pallor, and the uncon sciousness may be preceded or attended by an involuntary cry or scream. The patient falls unconscious regardless of surroundings, the muscles of the face and extremities become extended in rigid tonic, followed quickly by clonic spasm; frothy saliva, sometimes mixed• with blood, escapes from the mouth; breath ing becomes labored or stertorous from spasm of the respiratory muscles; the sphincters relax, allowing involuntary escape of urine, faces, and sometimes semen; the whole convulsive attack last ing from a few seconds to ten minutes or longer. This convulsion is followed, in typical cases, by a deep semicomatose sleep, lasting from a few minutes to sev eral hours, the • patient on awakening remembering nothing or very little of anything which occurred subsequent to the beginning of the convulsion.