The minor attacks (petit mal) exhibit an endless procession of variations. The disturb ance of consciousness is shorter in duration and less profound and the convulsive phenomena are so mild that they may even escape observation. Occasionally there is a slight convulsion, an involuntary contraction and extension of some of the muscles without loss of consciousness, and the patient resumes his regular course of work or play. In cases of a slight loss of con sciousness the patient may suddenly stop in the midst of play or work or conversation, a shade passes over his face and in a moment he is himself again. Sometimes there is a momen tary confusion, faltering or fumbling about the clothing in a dazed fashion, which quickly passes over and leaves the patient occupied as if nothing had happened. Occasionally he feels sleepy, lies down for a second and then gets up perfectly well. These attacks may also be preceded by an aura.
Psychic disturbances many and varied may precede or follow the attack or may even re place it. In many subjects there is a marked disturbance sometimes for several days pre ceding the convulsion, which serves as a warning to those associated with the patient. The mani festations may be increased irritability, com plaining, depression or dullness and perhaps also disturbances of the sensory functions, hypochondriacal complaints and hallucinations, all of which conditions are significantly re lieved by the convulsion. A condition of active excitement may, however, occur just after the attack, sometimes before, which may reach an actual frenzy, epileptic furor. In this state the patient is liable to any act of violence but fortunately the attack is usually brief and moreover the patient's efforts are diffuse and lack coherence.
The so-called epileptic equivalent is an at tack in which the convulsion is replaced by a purely mental disturbance. The form of at tack is frequently that of the epileptic autom atism or epileptic dream state. Almost any act may be committed in these conditions with absolutely no recollection on the part of the patient when he comes to himself. The recog nition of this condition is of great importance from a medicolegal standpoint for crimes are sometimes committed and these, if crimes of violence, are often marked by their ferocity and fury. Moreover, the seizure associated with these acts may have been so slight as not to have been noticed. Usually, however, the acts are rather simple and the attacks of short duration. There are also transitory conditions of depression, excitement, confusion, delirium and stupor and peculiarly characteristic one of ecstasy with hallucinations, particularly of a religious character. There are also transitory
states of ill-humor which may be psychical equivalents. These are frequently associated with drinking.
The etiology as well as the prognosis of epilepsy are so involved in the broader con cept which avoids the limitation of definitions and unsubstantial formulations that these are best considered also from the energic stand point. The genuine epileptic usually comes from a badly tainted ancestral stock, manifesting per haps not epilepsy in the ancestors or collaterals but evidences of ill-defined nervous disorders. There is evidently a defect of the germ plasm and hence epilepsy and feeble-mindedness are often found associated. This accords with what has been said about the inadequate dis tribution of energy discharge. There is actual developmental failure to lay down paths for the higher avenues of discharge and constitutional inadequacy to adapt to the demands of en vironment. The epileptic type of character is apt to be morose, irritable, suspicious and hypochondrical with resultant unreliability and shallow aggressive religiosity. He is marked by an extreme egocentricity and hypersensitive ness. This, it has been well said, °is not to be taken in any narrow or moralistic sense, but is to be considered . . . in a broad biologic view, a personality-defect which makes its pos sessor incapable of social adaptation in its best setting and which, if it remain uncorrected, renders the individual entirely inadequate to make a normal adult life. The seizure phenom enon is essential epilepsy . . . constitutes a reaction away from the difficulties in a loss of consciousness.° All the patient's interests centre about the ego. His interests are variable but shallow and easily fall away as they fail to contribute to his egotism or as they present some difficulty which calls for a greater effort without a suf ficient egotistic premium. .There is always a tendency to turn conversation or any external stimulus to the ego centre. In this as in all his reactions the epileptic manifests the infantile character to a marked degree. His sexuality like his religiosity is of a superficial, infantile, expansive type. The impulses are prominent and easily roused but undeveloped and tending to seek outlet in a number of ways which be long to the infantile polymorphus components of sexuality not yet converged into the adult sexual aim (Freud).