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Epilepsy

child, neurotic, boy, tendency, eyes, brain, attacks and disease

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EPILEPSY, a disease which may vary in severity from the most transient un consciousness to violent convulsions and profound coma, is not uncommon in children. It has been estimated that nearly one-third of the cases met with in the adult have begun under the age of ten years. The malady is one of peCuliar importance in early life, on account of its tendency to influ ence injuriously the development of the brain.

Causation.—In a large proportion of cases of epilepsy there is a hered itary neurotic, tendency. We often find a family history of epilepsy, of insanity, or of some form of nervous derangement. If this is the case on the side of both parents the child's prospect is a sad one, and in such families every child may be afflicted with some form of neurotic disturb ance. Habitual intemperance in alcohol on the part of the father or mother is said to have a determining influence in the causation of epilepsy in the child. Lancereaux insists upon the importance of this cause, and states that a tendency to convulsions in their offspring is a common con sequence of alcoholism in the parents.

Cachectic conditions resulting from imperfect nutrition or disease, such as anaemia, chlorosis, and scrofula, have been said to favour the develop ment of epilepsy ; but I can find no sufficient foundation for this statement. Rickets contributes largely to the occurrence of eclamptic attacks in in fancy, but it does not, according to my experience, especially predispose to epilepsy unless there be strong hereditary neurotic tendency ; for when the disease passes off, as it will do readily if the causes exciting it be re moved, the proneness to convulsive seizures also subsides.

Amongst the exciting causes of epilepsy violent emotions, such as terror and fright, take a prominent place. Injuries, such as blows or falls upon the head, are answerable. for many of the cases. It is also common to find the paroxysms attributed in the first place to eclamptic attacks occurring during childhood. It seems probable that in many cases of infantile con vulsions some change takes place in the brain during the course of the fit, which afterwards induces a return of the seizures without discoverable cause.

A bright, healthy little boy, aged eleven months, in whose family I could discover no neurotic history with the exception that his father and one of his uncles had had fits in infancy, was taken ill on August 31, 1870.

Some pustules appeared on his legs and he was feverish. On the next morning he was seized with a convulsive fit which lasted with occasional intermissions for several hours and left him paralysed on the right side. During the next three days he remained in a drowsy state and was feverish at night. I saw him for the first time on September 4th. The child, a healthy-looking boy, had but teeth. Still, although backward in this respect" for his age, he showed no other sign of rickets. He was lying with closed eyes on his mother's lap. His pupils were equal and acted well with light ; his pulse 146, was regular in rhythm but not in force ; his breathing was irregular interspersed with sighs, although without long pauses ; the temperature in the rectum was 101.6°. Both legs were covered from the knee to the ankle with an erysipelatous blush. Power over them was, however, being restored, for the child moved the right arm readily and the leg a little. At first they had been completely paralysed. His lungs and heart were healthy. The child seemed stupid but was not unconscious, for he watched a light passed before his eyes, and during examination of his chest cried and twisted himself about. When the teat of his feeding-bottle was given to him, he seized it eagerly and put it into his mouth. There was no paralysis of the face.

The convulsions in this case had been evidently an initial symptom of the erysipelatous inflammation, and must have led to a small extravasation or other structural lesion in the brain ; for although the child quickly re covered the use of his limbs, he became subject from that time to frequent slight fits, which were no doubt of an epileptic nature. They came on every two or three weeks without discoverable cause and lasted for one or two minutes. The boy was said to become suddenly very quiet ; then, in a moment, his cheeks flushed, his lips became purple, his eyes, although not exactly fixed, had an unnatural look, and he lost consciousness com pletely. He did not twitch. When the fit came on he never fell, for his nurse seeing his sudden quiet and anticipating what was to follow always took him up in her arms. In spite of treatment these attacks became con firmed, and in 1882—the boy being then twelve years of age—were still going on. Occasionally he had a more perfect seizure, but usually the at tacks were of the character which has been described.

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