The simultaneous occurrence of epi lepsy and disease of the heart is usually accidental and is most probably not de pendent on the same primary organic disease. Epilepsy may give rise to tran sient dilatation of the heart, but not to any permanent cardiac disease. When the two diseases are present together the cardiac disturbance is not the sole cause of the epilepsy, but other etiological influences—such as the neuropathic pre disposition, alcoholism, etc. — are also operative. Heart disease and arterio sclerosis favor the occurrence of epileptic attacks in so far as they influence the circulatory conditions in the cortical centres. This is observed with peculiar frequency in old age as manifested in senile epilepsy. Stintzing (Jour. Amer. Med. Assoc., Feb. 3, 1900).
Of interest in connection with the sub ject of general predisposition to epilepsy are the statements of Peterson that the disease bears a ratio to the general popu lation in this country of 1 to 500, and the further statement by Gray that a considerable majority of all epileptics have dark hair and eyes.
Reflex epilepsy, the existence of which is somewhat widely questioned, quite probably occurs, but in comparatively rare instances. Among the innumerable conditions of peripheral disease which have been noted as bearing an apparently causative relationship to the develop ment of epilepsy are phimosis, adherent prepuce or clitoris, stenosis of the uterine os, nerve-cicatrices or surgical disease of the limbs or joints implicating nerve trunks, carious teeth, eye-strain (eso phoria, exophoria), obstructive disease of the nasal passages, aural disease, etc., etc.
There is much to support the reflex theory in both experimental and clinical experience, although, as with many other phases of the subject, it is, as yet, no more than a theory.
Case of a young man complaining of severe pain in the head. Since child hood has had a chronic discharge from the right ear, and although he had never had any fits stated that he occasion ally felt giddy and at the same time experienced peculiar sensations of smell which he could not accurately describe except that they were very unpleasant. A few hours after admission to hospital he became delirious and died suddenly, and at the necropsy he was found to have an abscess situated in the anterior part of the right temporo-sphenoidal lobe. In more than one case a lesion in this region has given rise to an olfactory aura similar to that here described.
Campbell Thomson (Practitioner, Dec., '97).
There is a close and constant con nection between the excretion of urea and epilepsy. Every attack is preceded, twenty-four to forty-eight hours, by a diminution in the amount of urea ex creted, and as long as an epileptic ex cretes 0.0 to 0.3 urea during the day there is no danger of an attack, but, if the excretion falls to 0.45 or 0.35, one is imminent. Epilepsy may, therefore, de pend upon anomalies in the metabolism. Lithium carbonicum, 15 grains three times a day, produces a decidedly favor able effect. N. Krainsky (Jour. Amer. Med. Assoc., Apr. 16, '98).
Increased quantity of the cerebro spinal fluid is an important element in the production of epilepsy. What the exact condition may be that permits of such marked fluctuation as occurs in the quantity of this fluid in epilepsy is uncertain. Possibly a toxic element is responsible; more likely a defect in the activity of the lymphatic or excretory functions. William House (Buffalo Med. Jour., June, '98).
Aural disease and epilepsy often co exist without any causal connection, but a personal case reported shows a direct causal connection may exist between the ear disease and the epilepsy. Under the influence of treatment directed almost exclusively to the otorrhcea the crises became less frequent, and ceased entirely with cessation of the otorrlica, and im provement in hearing. During the treat ment a return of the otorrhcea was fol lowed next day by an epileptic seizure. M. Lannois (Annales des Mal. de l'Oreille, Oct., '99).
There is a class of patients whose epi lepsy seems to be directly traceable to gastrointestinal irritation. When these patients are about to have an attack the digestive difficulty seems to precipitate the crisis. Then, again, when the diges tion is corrected the crisis seems often to abate. In infants stomach trouble frequently produces convulsions which resemble epilepsy. These cases usually respond quickly to rational treatment.
Digestive troubles are frequently la tent, and it is to be recommended in all cases of epilepsy and suspected stomach disorder that an analysis of the stomach contents and urine be made. To deter mine the condition of the patient this should always be done, even if there be a want of subjective symptoms. The examination of the patient is not com plete unless the digestive organs are also examined. C. D. Aaron (Phila. Med. Jour., Oct. 5, 1901).