EPILEPSY. Epilepsy is no longer used as a definite disease name but rather as a sym bolic term under which are grouped a great variety of conditions presenting a general re semblance. These are sudden and relatively transient attacks accompanied usually bx dis turbances of consciousness called variously °faints," °absences,) °blanks) and amnesias and convulsive seizures which involve the voluntary and involuntary muscular apparatus.
The historic name epilepsy, the °falling sick ness,) points to the most evident symptom, the falling due to this loss of muscular control. The strictly etymological origin of the word, literally from the Greek word °to seize upon,0 also denotes the antiquity of the recognition of this form of disturbance and the ancient ani mistic character of the hypotheses which sought to explain it, and which has long clung about its mysterious and often violent manifestations. It was recogmized in its pure type by the most ancient observers. Hippocrates described it, and evidences are found in the earliest Indian writings of Charaka that the disease was then known.
The most modern belief concerning it is undergoing a process of modification. There is a tendency to speak of °the epilepsies) rather than to consider a disease entity, which fails to cover the wide range of conditions of which the attacks are but the outward manifestation. The dynamic concept which is making its way into medicine draws attention to the attacic as the result of a faulty distribution of energy which may be brought about in various vrays and frony a variety of far-reaching canses the constitution and experience of the individual.
The dynamic, .energetic concept of the nervous and psychic functioning establishes a working basis by dividing nervous activity into three levels of operation which have been pro gressively developed according to functional biological needs. Thus the nervous apparatus of man presents the capability of reaction to environment on the physicochemical or purely vegetative level, the sensori-motor and the level which must express itself symbolically as in all the higher psychic forms of reaction. Any one of these levels offers itself as an outlet for the epileptic discharge. The unity of the nervous organism permits the view of it as a mass of interrelated reflexes redistributing the energy bound up with the individual in order to effect his adaptations and his reactions toward his environment, which may thus take place at any one of the three levels. The epileptic in efficiency to so distribute the energy as to bring about a series of harmoniously adjusted ac tivities may in turn emphasize itself in any one of these spheres of discharge.
This accounts for the wide range of mani festations in attacks of the equally extensive underlying conditions. The attacics comprise psychic forms, the so-called functional neuroses and psychoneuroses, the more pronounced psychoses, also toxemic states, many organic brain diseases and the grosser defects of de velopment, even idiocy. The toxic states may be transitory with removable cause or may be due to defective metabolic functioning which cannot be remedied or to other obscure factors working at the 'physicochemical level. None of these causes in themselves can any longer be regarded as sufficient explanation of the epileptic form of reaction. The more funda mental conception of a faulty energy distri bution indicates a blocking or closing of many paths of outlet either structurally or by psychic inhibition and so accumulation of the discharge within relatively narrow confines. This view point applies thus equally well to the psychic manifestations, the physiological and localized attacks (Jacicsonian types) of the physicochem ical (tetany).
More accurate and pathological and clinical knowledge tends to separate off from the great epileptic group certain varieties of conditions which can be more definitely identified with other disease groups. There remains, however, for general consideration the still broad ald ill-defined °genuine or classical epilepsy) in which the typical reactions are evident for de scription. The classical major epileptic attack (grand mal) is sudden in onset though pre ceded often by a warning aura. This may be sensory, motor or purely psychic, At the sud den onset of the attack the patient falls and immediately develops tonic spasm with = consciousness. The direction of the pauent's fall depends upon the muscles first involved, but in a few moments all the voluntary muscles are affected. Cyanosis results from convulsion of the respiratory muscles and biting of the tongue from that of the jaw muscles. As the tonic convulsion is succeeded in a few moments by donic spasms frothy, bloody saliva issues from the mouth and the cyanosis gradually disappears through the return of respiration. Urine is often passed during the attack and less frequently feces. The gradual subsidence of the conic spasms is followed by a short period of automatic activity after which the patient re turns gradually to full consciousness or sinks at once into a deep sleep from which he awakens with lameness and weakness in the muscles which are affected, and perhaps with headache.