In simple syncope there is no motor spasm.
Hysteria is really a form of malinger ing, and the same tests apply. Here, as with other manifestations of hysteria, the disease-picture simulated is nearly always overdone. A strikingly-constant physiological mistake of the hysterical is the reversed of the epileptic order of the convulsive movements, beginning with the clonic instead of the tonic, or mixing them up indiscriminately. If the patient happens to be a woman and of any of the Latin races (and I would add Polish Jews) it is necessary to exclude, with special and elaborate caution, major forms of hysteria. In many forms of minor epilepsy, especially in cases in which the disease manifests itself through the medium of psychical or sen sory equivalents, a positive diagnosis is possible only after continued and close observation of the individual patient.
Prodromal symptoms are frequent in epilepsy, rare in hysteria; the aura is seldom absent in epilepsy, and the ac companying hallucinations often urge the patient to murder, burnings, and robbery; the aura is much less fre quently present in hysteria, and the accompanying hallucinations are less alarming, but are of longer duration. The initial cry in epilepsy is piercing, the patient grows pale, and falls uncon scious, possibly wounding herself; the hysterical patient is never entirely un conscious, and does not suffer any injury. The dilatation of the pupil, rigidity, con gestion of the face, and salivation are more constant in epilepsy than in hys teria. The tonic and clonic convulsions are much more intense in epilepsy, in continence of urine and faeces is more frequent, and there is usually present complete ansthesia,—occasionally hy permsthesia. The pulse during the epi leptic seizure is small, scarcely palpable, but slightly changed during the hyster ical attack. The termination of the attack is more lytic in epilepsy, more critical in hysteria. Finally, the hyster ical is particularly susceptible to sug gestion and hypnotism, and their attacks may be, by these measures, controlled for a long time, whereas the influence of these agents over the epileptic is min imal. Bonjour (Revue 1116d. de la Suisse Rom., No. 2, '96).
The great-toe reflex in epilepsy, a new diagnostic sign. Case of Jacksonian
epilepsy in which this phenomenon could be evoked immediately after the attack on the convulsed side, while in the in tervals free of attacks the plantar reflex was normal. J. Babinski (Semaine 1116d., No. 4, '93).
Case of a patient suffering from intra cranial tumor, and subject to attacks of generalized convulsions, with loss of con sciousness and incontinence of urine and fasces in addition to loss of the anal re flex, in which the great-toe reflex was observed on both sides, while the tendon reflexes remained unaltered. In a quar ter of an hour after the beginning of an attack, the patient, having now regained consciousness, the anal reflex reappeared, and the cutaneous plantar reflex was nor mal. J. Babinski (Soc. de Neurol. de Paris, July 6, '99).
Cardiac epilepsy cannot, in its incipi ency, in some cases, be differentiated from angina pectoris. The association of arteriosclerosis or other evidences of vascular degeneration, common to both conditions, adds to the confusion. Epi lepsy occurring only at night may exist for years unrecognized. Sleep-walking, persistent nocturnal enuresis, and other similar phenomena should always gest an inquiry as to the existence of epilepsy.
In the epileptic psychoses a dream-like, altered condition of consciousness is prob able, and not by any means a total or partial amnesia. The most various tran sition-forms occur between the different forms of so-called acute and chronic epileptic psychoses. Epileptic or epilep toid conditions and psychoses must alike be reckoned as symptoms of cerebral disease. The transitory, dreamy states are characterized by the rapidly-recur ring, apparently orderly, indifferent, and inconspicuous manifestations, and by un usual, unexpected, often violent, acts. There is no epileptic psychosis without epileptic or epileptoid antecedents. Epi leptoid conditions are more frequent than is commonly supposed, especially vertiginous attacks. With the lack of epileptic or epileptoid manifestations, all other symptoms, such as amnesia, sim ilarity of the attacks, peculiarities of actions, sensory hallucinations, will serve to make the diagnosis of epilepsy most probable. E. Siemerling (Berliner klin. Woch., Nos. 42, 43, '95).