Blepharospasm in childhood is often hysterical. It usually follows spasm of the eyelids due to the reflex irritation of some inflammatory disease of the eyes and is therefore a kind of hysterical autoimitation or, to use Bruns' expression, thc hysterical permanent manifestation of an organic disease. Like all hysterical manifestations produced in this way by autoimitation, blepharospasm is difficult to treat and in that respect, as well as in its origin, resembles the various forms of tie and stereotypia, in which the prognosis is bad. We shall return to this subject later on.
Among motor irritative phenomena contractures have already been mentioned. Choreatie movements are often observed. Many of the relapses of genuine chorea that are of short duration ancl accompanied by marked muscular hypotonia must be regarded as hysterical, as has already been pointed out in the chapter on chorea. Tremor is not common. The following case reported by Hussy came uncler our own observation.
A country boy twelve years of age, vigorous and healthy except for occasional stabbing pains in the chest and back, headache and "short ness of breath." Four weeks ago a tremor began in tbe hands whenever the boy began to eat, and made it impossible to carry the spoon to the mouth. On examination it is found that he is able to perform compli cated movements without any difficulty and writes quite nicely; but when a glass of water is placed in his hand, and he is told to hold it steady or drink out of it, a coarse, violent tremor develops so that he spills the water. The tendon reflexes are exaggerated; pain, taste and temperature sense are normal. A prompt cure was effected by a single painful application of the faradic current, and the boy- WaS able to per form the above-described movements without difficulty. The few cases contained in the literature are cited by Hussy.
Multiple paramyoclonus (Friedreicb), the classification of which in adults is still a matter of dispute, appears to be almost exclusively hysterical in children (Delvart). Only one of the cases so far described later turned out to be a ease of multiple sclerosis.
Electrical chorea, to which a separate chapter has been devoted (page 324), may also develop on a hysterical basis. The same is true of rhythmical chorea and facial spasms, and the various forms of tic, which are described at length in another place.
The convulsive seizures form an important group of hysterical manifestations. They may take the form of chorea magna as described
by Chareot and his school, but usually occur in older children, and in that case are practically identical with grand mal hysterique, the diagno sis of which presents no difficulties. When thc attacks resemble epilepti form seizures, however, the diagnosis is not so easy. They may be unilateral, confined to ft single extremity, or universal; they may be ushered in by a kind of aura and may- be followed by peculiar confusional states and the like, thereby suggesting a genuine or a cortical epilepsy if the phpician has to depend solely on a laymen's description.
But if the physician has the opportunity of observing the attack himself, which is often possible at the first visit because the attacks are readily brought on by suggestion, he is soon convinced that the alleged unconsciousness, which the parents usually infer from the fact that the child does not answer, in reality does not exist, that the pupils react, and that the character of the muscular contractions and convulsive attitudes is much MOre complicated and theatrical than in epilepsy. Moreover, the sphincters practically never relax during hysterical convulsions, so that there is no involuntary discharge of urine or feces, nor does the child bite its tongue or do itself any other injury in falling. The presence of the three last-named symptoms is much more in favor of epilepsy. Cases of hystero-epilepsy, by which is meant an intermediate form between the two neuroses or a simple association of the two neu roses in the. same individual, have, so far as I know, never been observed in children, although their occurrence is quite as conceivable as in adults. It is worth noting that in many cases the daily return of the attack at exactly the same hour at once awakens a suspicion of hysteria. For the rest, the diagnosis is determined by the general viewpoints which have already been described.
The delirious states which frequently- accompany or alternate with the hysterical convulsive seizure may occur independently in children. Itenoch in his conferences describes eases of this kind with sudden and usually terrifying delirium,with violent ravings and loud outcries, which appear to be produced by terrifying hallucinations or visions. The same observation has been made by Bruns, Eulenburg and a number of Fre.nch authors.