In petit ma!, the loss of consciousness lasts two or three seconds, and the patient does not fall, but simply suspends operations, stares fixedly be fore him, gasps, and resumes consciousness, gen erally without knowing that he had experienced the attack. No treatment is necessary during the attack.
In psychic epilepsy there are the usual premonitory conditions noticed. After a period of despondency, irritability, restlessness, dread, giddiness, or, in some patients, intense ela tion, in others an exhibition of voracious appe tite, instead of a fit the patient experiences a sudden attack of laughing, weeping, or shouting, with extravagant gesture and maniacal appear ance, and even in some examples with uncontrol lable homicidal impulse devoid of motive. This is the psychic equivalent.
In Jacksonian epilepsy, there is no loss of con sciousness; the spasmodic movements are con fined to a limited area or to one extremity. It is generally due to tumor of the brain in the part of that organ which the 'signal symptom,' or part convulsed, indicates; it may be due to ab scess of the brain, injury, or meningitis.
The ultimate danger of the disease has little relation to the severity of the individual fits, except in the modified sense explained above; the frequency of the attacks being apparently much more apt to influence the duration of life than their character. Indeed, although epileptics may survive several severe paroxysms at distant inter vals, and recover in the end with an apparently unbroken constitution, it rarely happens that very frequently repeated attacks, especially of the petit man, are unattended by some permanent de preciation of the powers of mind or of body. The most frequent, perhaps, of all the more serious consequences is insanity (q.v.). Sometimes the development of epileptic insanity is attended by palsy, and other indications of structural dis order of the brain; in other instances, no such consequences occur, and the brain after death may be found to have very little tangible disease, or only such disease as is found in numerous other eases of functional derangement. Very often there is loss of memory. Yet history fur nishes several examples of epileptics who were men of unusual mental aidlity and intellectuality, as e.g. Julius Caesar, Petra rch, Peter the Great. Mohammed, and Disorders of the diges tion are also not uncommon, and there is fre quently a want of tone or vigor in all the bodily functions, which communicates an habitual ex pression of languor and reserve to the epileptic.
In some cases of grand ma!, the patient has a succession of fits, one after another, without re gaining consciousness for several hours. This is termed status cpilepticus, and is a grave condi tion, as the patient may die in it. After an at tack of grand or petit mal a patient may experi ence a condition of reduced consciousness, during which he wanders off for a day or a week, enter ing shops, talking with people, eating in restau rants, and otherwise acting as if conscious; on awakening he forgets entirely all that has hap pened. Or there may be a post-paroxysmal psy chic manifestation in which the patient is furious and homicidal.
Masked epilepsy, or epilepsia larrata, is the term given to a condition succeeding a minor at tack of epilepsy, in which there are random re marks made and automatic acts performed by the stupid and dazed patient. Gowers is responsible for the statement that imperfect loss of conscious ness with automatic action constitutes the minor seizures in some cases, without any initial epilep tic stage. He considers epilepsy as a disease of the gray matter of the brain, most frequently of the cortex, which results in an impairment of the resistance of the nerve-cells to the liberation of energy. A sudden and violent liberation of nerve force results in derangement of function and im pairment of consciousness. Certain eases un doubtedly depend upon organic disease, as tumors or injuries to the brain and its membranes, more especially near the surface. Local sources of irri tation in other parts of the body have acted as reflex exciting causes of epilepsy, and cases are recorded in which the disease has been cured by the amputation of a finger or the division of a nerve. The treatment of epilepsy should consist of alleviation of conditions and depends upon the variety of the disease. Iron, zinc, nitrate of silver, borax, digitalis, antipyrine, the bromides, and many other drugs have been used. Bromides con trol the fits, while they are used, in almost all cases, hut are not curative. and their effect is deteriorating and deplorable. Attention to the digestive tract and prevention of fermentation therein, out-of-door life. proper food (a most im portant matter), and baths have resulted in re covery in a few cases. Any treatment must he prolonged at least two years. Marriages of epileptics should he absolutely forbidden.