The severe convulsions which occur at comparatively long intervals seem to have a less disastrous influence upon mental development than the milder epileptiform seizures which occur more frequently. Also, as has been before remarked, the age at which the seizures begin is a very impor tant matter. If the child has been subject to them from before the com pletion of the first year of life, his mental development is almost certain to be injuriously affected.
Sometimes choreic movements occur in epileptic children, for there appears to be an association between the two diseases. A choreic child may develop epilepsy; and a child subject to epileptic fits may become choreic. Dr. Gowers has published some interesting cases illustrating this connection.
Diagnosis.—An eclamptic attack in infancy and early childhood pre sents exactly the same characters as a fit of genuine epilepsy, therefore it is very important to decide in every instance to which class of convulsive disease the attack is to be referred. This question has already been dis cussed elsewhere (see page 282).
Epileptic vertigo, when it takes the form of loss of consciousness with out muscular spasm, is liable to be mistaken for an attack of syncope, especially in those cases where there is great pallor of the face. The seizures, indeed, are constantly spoken of by the parents as fainting fits, and we must be on our guard against this interpretation of the phenome non. But syncope, although not uncommon in young people, is seldom seen except as a consequence of weakness, prolonged and exhausting dis ease, or flatulent accumulation occurring in an aninic child. Epileptic children are often robust and generally appear to be well nourished. Again, slight twitching of muscle, combined with complete loss of con sciousness, would point to epilepsy. In syncope there are no twitchings, and if any muscular movement occur insensibility is not complete. Lastly, an epileptic attack is sudden, and when the child recovers he is ignorant of what has passed ; syncope is preceded by a very distinct sense of " faintness," and after the attack is at an end the patient is quite aware that he has been unconscious.
Cases of cerebral disease with partial convulsions may be mistaken for this disorder, but in such cases there is a history differing widely from that of epilepsy, and other symptoms of cerebral disease are present. Be sides, in the attack we do not find the peculiar interference with respiration which is so characteristic of an epileptic seizure.
Even in the case of children it is necessary to be on our guard against the hysterical simulation of epileptic seizures both on the part of boys and girls. These false attacks can be usually recognized without difficulty. A boy, eleven years of age, was admitted into the East London Children's Hospital under the care of my colleague, Dr. Donkin, with a history of fits which were supposed to be epileptic. There was no neurotic tendency in the family, and the patient had always been healthy until the beginning of July, when he was noticed to look pale. He was said to have been exposed shortly before to a hot sun, and also to have received a heavy blow on the head of which for some time he seemed to feel the effects. On July 13th he had a fit in the night, which was supposed to be a faint. During the next fortnight he suffered frequently from the attacks, often passing through as many as eight or nine in the day. The description given was that he felt giddy, fancied he saw "things going round him," made a clutch at some imaginary object, and then with a cry fell backwards. He was said to foam at the mouth, but not to bite his tongue although he clenched his teeth firmly ; to make convulsive movements with his arms as if fighting ; and sometimes to lie motionless with closed eyes. The mother thought he lost consciousness. The fit sometimes lasted half an hour. It was not fol lowed by stupor, but the boy remained for some time oppressed and weary, and stammered when he attempted to talk.
The first day he passed in the hospital he had eight attacks. In these he struck out with his arms, dashing his hands against the bars of his bed, but always striking with the fleshy part of the fist, never with the knuckles. He also kicked out with his feet as if keeping off some enemy. He threw back his head, and his face was much flushed by his exertions. It never became blue, nor was there any arrest of respirations. The eyelids were closed and he resisted opening them. When the conjunctiva was touched he winked. The pupils were not dilated. He did not injure his tongue even if he caught it between his teeth, and all his movements had a cer tain voluntary character. There was no stage of tonic contraction. After the fit was over he lay down with closed eyes as if to sleep.