ECLAMPSIA INFANTIral The clinical picture of this condition so elosely resembles that of epilepsy that until very reeently eclampsia was regarded merely as a form of epilepsy characterized by the age of the patient and a favorable elinieal eourse. The attacks consist of a primary tonie, and secondary clonic stage. A kind of aura is also frequently observed. The children beeonie restless, distra ft, inattentive, and anxious. This stage lasts at most but a few minutes, usually only a few: seconds, and is followed by sudden pallor of the face, loss of con sciousness, and a tonie convulsion of the muscles of the eye, the face and the extremities. After a few seconds these are replaced by clonic contractions, at first violent, shaking the entire body at each paroxysm as though a powerful eleetrie current were passed through it, to use Soltmann's eomparison, with irregular staccato, often audible breath ing, approaching a cry, considerable eyanosks and profuse sweat. Grad ually the convulsion subsides, and after one or a few minutes the attaek terminates in a general relaxation and return to conseiousness. If the attack lasts longer than five minutes at the most, the functional char acter of the convulsions must be called in question.
The similarity to epilepsy is increased by the fact that in many attaeks the irritative phenomena are quite oN:ershadowed by the loss of consciousness, and a clinical picture is produced which may quite readily be compared to the petit mal of epileptics.
The duration of the individual attack as a rule does not exceed a few minutes, at the expiration of which time the ehild again appears normal or at most somewhat peevish; the postepileptic stage of sonano lenee, which is so frequent after epilepsy, is absent.
In severe cases, however, the attaeks may be massed and occur at short intervals, so that we are justified in speaking of a status eclamp ticus analogous to the status epileptieus. The number of attaeks that may possibly occur in children the subjects of celampsia varies within very wide limits. While one patient may not have more than one or a few altogether, another child may go through ten or twenty or even more attacks in the course of a single day, and may never suffer from them again, or may be free for a. long time; a third may have attacks at varying intervals for days or weeks. The clinical course depends partly on the severity of the disease and partly on the treatment, which will be discussed later. Death during an eclamptic attack is a com
paratively rare event; at least there is 110 doubt that laryngospasin and expiratory apnoea are much more dangerous in this respect. The usual termination of these attacks is in complete recovery without any permanent damage.
To what extent the mental (psychic) impairment which is some times observed in children who have suffered from eclampsia at some previous dine is related to the eclamptie attacks, is a difficult question to decide. What we have to say- on this point will be found in the chapter 011 Epilepsy (see page 336).
Eclampsia infantum can be differentiated from other functional or organic convulsions in early childhood by examining the patient during the intervals of freedom, with due consideration of the character and duration of the attacks themselves. Whereas an celamptic child pre sents only the symptoms of the spasmophile diathesis during the intervals between the attacks, meningitic, encephalitic or toxic symp toms are found in other conditions. Fever never occurs in uncom plicated eclampsia and is always indicative of the associated infection which may possibly be the primary cause of the convulsions. (See also the chapter on serous meningitis, page 423).
Late Forms. —111 the great majority of children eelampsia dis appears at the end of the earliest infancy, and t.he children remain free for a time from manifestations of the spasmophile diathesis, the latent symptoms of which, however, inay be demonstrable years later and possibly until adult age. A small minority go through attacks of convulsions usually isolated, but in every respect resembling epi lepsy, during the third, fourth, or even the seventh and eighth year of life.
-We have not a doubt that the attacks are rarely recognized as "late eclampsia" and differentiated from epilepsy; such a diagnosis is possible only by searching for spasmophile symptoms and taking into account all other accessory circumstances. Since the prognosis of late eclampsia is favorable, in contrast to the unfavorable prognosis of epilepsy, the differentiation of the two conditions is of the greatest importance. These points and the question of the transition between eclampsia and epilepsy will therefore be referred to again in the chap ter on Epilepsy.