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Epilepsy-A

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EPILEPSY.--A disease of the nervous system, occurring periodically, and characterised by disturbances of consciousness. 1 t is usually, though not invariably, accompanied by complete loss of consciousness and by con vulsions. All the causes of the disease have not yet been fully determined. Heredity is probably of considerable importance in the etiology, for the descendants of epileptic, mentally deranged, or alcoholic parents are fre quently afflicted with the disease. Alcohol plays a very noteworthy part, as about one-third of all chronic alcoholics become subject to epilepsy. Marked psychic disturbances, such as a severe fright, may prove the imme diate cause for an epileptic convulsion ; but this can only happen where the system has been prepared, as by hereditary tendencies, etc. A healthy normal person never becomes epileptic from fright alone. It is necessary to distinguish a primary from a secondary epilepsy, the latter being due to an injury to the brain or to the irritation of cicatrices along the nerve-roots. The great majority of the epilepsies are due to injuries to the brain at birth. The disease may cirn2 on at any time of life, but it occurs more frequently during childhood and youth. Very often the so-called " teething cramps " are of epileptifortn nature.

During a severe seizure the patient falls down unconscious, sometimes first uttering a loud cry. The body becomes rigid, the head is bent back ward, the limbs are extended, and the face becomes blue owing to the difficulty in breathing. A few moments later the entire body manifests convulsive movements—the head is tossed about, and the limbs are jerked violently. Tight contraction of the jaws often produces an injury to the tongue, so that bloody froth shows at the mouth. Urine and faeces may also be voided involuntarily. The attack lasts only a few minutes. The convul sions cease, the body relaxes, respiration again becomes free, and the patient awakens without any recollection of what has taken place, the only evidence of what has occurred being marked by the lacerated tongue and a feeling of fatigue which he experiences. Patients are usually very drowsy following an attack. Very often an attack may be presaged by peculiar sensations (the lasting hut a few seconds or minutes. These are

chiefly characterised by a variety of nervous manifestations, rush of blood to the head, palpitation, etc.

Aside from this complete attack there is another and less violent variety which is marked by a brief transitory fainting-spell, vertigo, or unconscious ness. I if these patients are suddenly overcome while reading, eating, or otherwise occupied, they will be observed to stare in an absent-minded way, and then continue whatever they have been doing as if nothing had happened. Of the seizure itself, they are absolutely ignorant.

An epileptic attack may come on at any time, day or night. Patients with nocturnal attacks are often unaware of the condition for a -long time.

A seizure may readily be induced by mental disturbances, exhaustion, or by a debauch. Sometimes as many as forty or fifty attacks may occur in one day, and may cause death from over-exertion of the heart-muscle. A single attack, although an alarming sight, does not endanger life.

The conduct of most epileptics changes during the progress of the disease. They become irritable, quarrelsome, and egotistic ; and if their wishes are not satisfied they get very much excited, and even belligerent and brutal. A distrustful and insistent manner is often combined with a certain amount of bigotry and hypocrisy. Their sense of the truth is often blunted, and their oath in court is not to be trusted. In other patients there is rather a diminution of mental capacity—a narrowing of their horizon of observa tion ; and a certain mental deterioration enters into the foreground of their symptoms. In the course of the succeeding years this mental weakness may develop into actual idiocy, especially if the epilepsy was present before the development of the mind was fully completed. In addition to the continuous disturbances of the mental functions, the attacks may be accompanied by more transitory disorders of the intellect, in which a clouding of consciousness is the most marked characteristic. This may go on to delirium, with hallucinations, fright, and great excitement. These patients are a source of danger, and many homicides are committed by them while in an epileptic state.

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