In all varieties of epileptic vertigo, loss or clouding of the conscious ness, which may be momentary, is the main feature, and is sometimes the only symptom. Thus, a child while engaged at his lessons or his play stops all at once in what he is doing and rests for a time perfectly quiet with dilated pupils and a strange fixed gaze ; then after a few seconds he re covers himself and continues his occupation. Instead of being perfectly still, he may mutter some incoherent words or may perform some curious or unexpected act. Sometimes his face may lose its colour, or a twitch ing may be noticed in one cheek, lip, or eyelid, or his head may be drawn to one side. In any case, when consciousness returns the child is quite ignorant of what has passed, and immediately continues the action in which he was engaged. In other instances he merely seems for the time to be, puzzled and confused, and does not recognise his friends. In other cases, again, an ordinary peaceful and affectionate boy will suddenly do some savage or spiteful act which is strangely foreign to his real disposi tion, and which afterwards he is quite ignorant of having perpetrated.
A little boy, aged twelve years, well nourished and healthy looking, had always been well until September, 1877, when he had an attack of pertussis. During this time he noticed that objects " looked small " to him for a moment. On recovery from the whooping-cough he returned to his clay-school, and one evening, when doing his lessons, he seemed all at once to be "puzzled and confused, and did not know his father." Since then he had had some well-marked epileptic fits.
The boy was brought to me in May, 1878. He then complained of slight but constant shooting pain in his right temple. I was told that he seldom had a genuine epileptic fit, but that he was very subject to attacks of mental aberration in which he did strangely spiteful things. The at tacks were said to last from a few seconds to ten minutes and to end in a stupor of about a minute's duration. On recovery he was always quite ignorant that anything extraordinary had occurred. While standing be fore me the boy had an epileptic seizure. He turned his face away over his left shoulder, remained for about thirty seconds perfectly motionless, and then fell backwards into his mother's arms. His face continued per fectly placid and did not change colour. The eyes were closed, and when the lid was raised were seen to be turned upwards and to the right. There was a faint twitch noticed twice in the fingers of the right hand. The pulse was full and regular. After being in his mother's arms for about sixty seconds, he suddenly changed his position ; and then in another minute sat up, looked about him, and seemed quite recovered.
Attacks of epileptic vertigo may come on suddenly, or may be preceded by certain premonitory warnings, which soon come to be recognised by the friends as likely to be followed by a seizure. The warning may be a headache, a pain in the body or a limb, an attack of sickness, the con traction or spasm of a muscle, or some curious change in the habits or disposition of the patient. It may precede the attack by several hours or a day or two. Sometimes it occurs without being followed by a fit. Epi leptic vertigo often in time develops into the more pronounced form of the disease. Usually, as in the ease above narrated, rare attacks of gen uine epilepsy are separated by long intervals, during which the patient is afflicted by repeated seizures of the disease in a milder form. Often the severer fits occur only at night and may be thus overlooked for a time. Epileptic vertigo always recurs much more frequently than the genuine epileptic seizures, and the patient may suffer from many such attacks in the course of a single day.
Between the attacks, whether of the graver or lighter form of the dis ease, the child may seem perfectly well both in mind and body. He may be animated, intelligent, active, and seem in no way harmed by his afflic tion. In other cases, especially if the attacks have dated from infancy, there is manifest interference with mental development, and the child may either have the manner and intelligence of one much younger than his age, or be dull and stupid even to idiocy. In the case already referred to—the little boy in whom the attacks began at the age of eleven months —when four years old he was intellectually on a level with a child of half his years. He sat on the floor and played with his toys with the manner of a baby, and had only learned to feed himself during the previous six months. Although he understood all that was said to him, he could only say a few words, and could not letters s, 1, n, or m. At the age of five years he began to have daily lessons from a governess, who re ported him as "not difficult to teach." At twelve years of age the fits still continued, although they were, as a rule, mild and infrequent, and oc curred at intervals of six weeks, two mouths, or longer. His father stated at this time, in answer to a letter making inquiry as to the boy's progress, that his mental power was below the average, and that the lad was far behind other boys of his age.