In petit mat both motor spasm and un consciousness are involved in far less gree, as the term indicates. Very often, indeed, the disturbance is of one sphere alone apparently, the attack consisting of a transient loss of consciousness alone, without motor spasm, or of motor spasm unattended with perceptible loss of con sciousness.
Not only may the motor spasm occur alone; it may be further limited to one limb or to one set of muscles, or even to a single muscle. Such limited spasms are, however, observed—we have reason to believe—only in the organic epilepsies belonging to the Jacksonian, or so-called cortical, group. In such cases the limb or muscle involved points with local izing significance to the site of the dis ease-process in the corresponding centre in the cortex. This statement is true, though of less value, as regards the vari ous forms of sensory and psychical epi lepsy. Among the rare clinical forms of atypical epilepsy most of which are of the petit-mal group are epilepsia pro cursiva, E. nutans, E. loquox, cardiac ep ilepsy, and migrainous epilepsy. Ep ilepsia procursiva is a form of the dis ease in which "the attacks consist in a straight or circling run, of a variable dis tance, which is rarely followed by a fall or course, but by facial congestion" (Hare). The patient may run to the left or right or straight ahead. The act is essentially involuntary, of course, though absolute unconsciousness may not occur. This purposeless run may constitute the entire clinical phenomenon: it may rep resent the first stage of an ordinary ep ileptic attack; it may occur as a post epileptic phenomenon.
epilepsy is peculiar to child hood and youth. It may be present many years before merging into ordinary epilepsy. It is impossible to localize the disease anatomically, but it is not war rantable to assume that a cerebral lesion is the organic cause. It appears to de velop especially in persons with marked cerebral lesion, but it is nevertheless probable that it, like all other epilepsies, may occur without demonstrable altera tion in the nerve-centres. It is often complicated with moral insanity. La dame (Inter. klin. Rnnd., Feb. 3, '39).
In epilepsia nutans, a minor form of Jacksonian epilepsy, the motor spasm is limited to the muscles of the neck, caus ing nodding of the head alone. In ep
ilepsia loquox the attack consists in an explosion of speech, the focus of disease being presumably limited to the speech centre. In cardiac epilepsy the attacks at first may resemble closely either an gina pectoris or simple cardiac syncope. The patient has little more than an aura of prwcordial anxiety, usually at night, or when lying down with transient con sciousness, but without motor spasm. There is in such cases either a brady cardia or a tachycardia, rarely a normal pulse, usually no organic cardiac disease, but often some arteriosclerosis.
It is at first a petit mal. Gradually, as a 'rule, the attacks become more severe, and finally may assume the major, or grand mal, type. This fact of transition in these milder forms to the severer forms of the disease is true of all cases as a possibility, although in many pa tients a petit mal remains such.
Migrainous epilepsy is a form of the disease in which habitual migraine may be either succeeded by true epilepsy of major or minor type or the epilepsy be succeeded by migraine, or the two condi tions may alternate in the same patient. In some instances many phenomena of both diseases—if they be really two— may be noted simultaneously. I have seen two such instances.
The frequent co-existence of epilepsy and migraine emphasized. Usually the epilepsy appears later than the migraine. One of the conditions. however, cannot be mistaken for the other. In instances where such a condition might have been possible it was seen that the migraine was a. symptom only of the underlying epilepsy or the epilepsy appeared as a new element in addition to the migraine. It is not always easy to decide in atyp ic-al cases whether epilepsy or migraine is the main pathological condition. A neuropathic predisposition is always present in these eases, and frequently secondary etiological elements are pres ent,—syphilis, alcohol, and other intox ications, injuries, arteriosclerosis, and excessive physical or mental efforts. Wilhelm Strohmayer (Miinchener med. Wochen., March 10, 1903).