Definition

This is an affection of the nervous system, characterized by spasms or convulsive movements, with unconsciousness. In the lighter forms there is unconsciousness without the convulsive movements. The light forms of the disease--those that are free from convulsive movements--are called "petit mal." The loss of consciousness accompanied with convulsive seizures is known as "grand mal." Convulsive movements localized without loss of consciousness are called "epileptiform," or sometimes "Jacksonian epilepsia." It is due to disturbance of the motor center. There are very few cases of organic disease of the cerebral cortex.

Etiology

The majority of cases start before puberty. Indeed, the convulsions of infancy are simply epileptic seizures, but they are seldom called epilepsy until they become established and recur at more or less regular intervals. This is a disease that belongs to the neurotic diathesis.

So far as sex is concerned, there are probably sixty per cent of the cases among mates. It is possible that a larger percentage of males are known to have the disease, if statistics were compiled that would be absolutely reliable. The reason for this is that the male is more active than the female--even in germ life, on through embryonic life. It is not generally known that men are more nervous and active than women, and it would be perfectly natural for them to develop more nervous diseases. Even if they were not by nature more nervous, their habits of life are such that they create nervousness. They are more inclined to take up with stimulating habits. They are decidedly more sensual; hence more inclined to develop nervous diseases. No doubt there are hereditary tendencies for epilepsy to develop in families; but no disease is hereditary in the sense that it is inherited. Children born of neurotic families, brought up in a way to develop their neurotic temperament, will certainly be more inclined to develop this disease than others.

Alcoholism is recognized as one of the leading causes for the development of epilepsy; but I think that it would be impossible to prove that alcohol causes more epilepsy than gluttony, tobacco, coffee, and tea. Indeed, it is safe to say that without gluttony there would not be nearly so much alcoholism. Overeating paves the way for all stimulating habits. And, so far as developing nervous diseases is concerned, toxin poisoning is equal to alcohol poisoning. The profession generally is of the opinion that syphilis predisposes to the disease. The life that exposes sensualists and libertine to syphilis has as much to do with developing epileptic disease, and other nervous diseases, as the socalled venereal disease.

Reflex Causes

Dentition, worms, adherent prepuce, masturbation, venery, foreign bodies in the ear, eyestrain, any disease that is of a painful order and has a tendency to produce reflex irritations, may be the starting point of epileptic convulsions.

When developed after thirty-five years of age, the cause is wine, women, and sensuality in all forms.

Symptoms

Preceding the convulsion there is a period known as aura. This is described differently by different patients. Some will complain of pain in the hand or finger; or there may be a disagreeable sensation felt in the stomach, or a feeling of precordial oppression, like smothering. As the disease is oftener brought on from gastro-intestinal derangement than from any other single cause, it is more probable that the aura will be that of a feeling of irritation in the stomach and bowels. The patient will utter a cry or groan, and is off in the convulsion without being conscious of having made an outcry. Those who have been accustomed to taking care of these patients know instantly, when they hear the outcry, that the convulsion is on. The patient usually falls on one side; the head is turned and drawn back; oftentimes the heels and the head jerk backward. Then again the jerking will be from side to side, so that a patient lying on the floor will pound his head against the floor, and the convulsion, when severe, will be a contraction of all the muscles from head to foot. These are called tonic spasms. The contractions and relaxations follow each other in rapid succession. It is very exciting to those who see a patient suffer convulsions for the first time. They are always anxious to do something.

Coma

Breathing is, uneasy. The face is congested ,and becomes very cyanosed. The patient will chew his tongue, froth at the mouth, and, after the convulsion has ceased, be will lie in a comatose state for from several minutes to several hours. If left alone, he will probably sleep for several hours after the fit has passed, because he is worn out completely. Those patients who have night occurrences of this disease will know that they have passed through one when they wake up the next morning; for their tongues will be quite sore, and their muscles will be painful and feel as though they had been bruised.

The "petit mal" is the epilepsy without the convulsions. The attack consists of loss of consciousness. The patient may be passing out of a room, and, as he reaches for the door-knob, a spell of unconsciousness takes hold of him, and, instead of taking hold of the knob, his hand passes to one side of it. He will become conscious at once, and think it strange, or possibly feel vexed at his awkwardness, that he did not take hold of the knob the first move. He may think of it afterwards, and he may not; but it is something which he cannot explain.

Some of these cases will be in conversation. When an unconscious state passes over them, they lose the thread of the discourse for a moment; then come to a state of sensibility, and continue the sentence they had started; which, of course, appears strange to those who have been engaged in the conversation. The hesitancy cannot be explained.

The "Jacksonian epilepsy" is known as cortical, or partial, epilepsy. It is always distinguished from the, ordinary epilepsy by the fact that patients with this type of the disease do not lose consciousness. Irritative lesions in the motor zone are usually the cause. The spasms begin in a limited number of muscles. They may begin in the face, arms or legs, or the thumb, or the toe may twitch. It may be that the patient previous to the contraction will have a feeling of numbness or tingling in the parts. The disease may involve the muscles of one leg only or of the face. The patient may remain conscious throughout the spasm and watch the course of it with interest. The beginning may be very slow. The patient may have time to become comfortably seated before the attack becomes too severe. The location of the spasm may continue the same for years. There is always a tendency for partial epilepsy to become general. This disease is frequently found in children following partial paralysis--the so-called post-hemiplegic epilepsy. The convulsions will begin on the affected side.

Diagnosis

The suddenness of the attack and the loss of consciousness, with contraction and relaxation following each other in rapid succession, are characteristic of the major form of epilepsy. The sphincters relax, the urine passes from the bladder, and sometimes the bowels are emptied. The convulsion caused by uremia is epileptic in character. The type of convulsion can be determined by an examination of the urine. "Epilepsy in a person over thirty who has not had previous attacks indicates organic disease of some kind." This I have not found true. I have found such persons as amendable to treatments as others. All the cases I have been called upon to treat have been curable--simply because the exciting cause was functional. Jacksonian epilepsy is distinctive, and it is hard to determine always on what the spasms depend. Irritation of the motor centers may be caused by many things. So far as I have been able to discover, all cases present toxin poisoning, and, because of this toxin poisoning, gastro-intestinal decomposition is always present. Of course, uremia may have much to do with it, but the kidneys have been brought into a state of inflammation because of the toxins in the blood.

Prognosis

The prognosis is favorable when cases do not depend upon an organic disease that is incurable.

Treatment

The disease is very easily controlled in children, provided the parents can be induced to take the proper care of them. They must be kept away from excitement, and fed very plainly, and at stated intervals, three times a day, and never between meals. Children must be controlled with a firm but kind hand. To indulge such children is to confirm them in their sick habit. Very strong people may develop this disease. In the adult, bad habits of eating, overstimulation of all kinds, abuse in the line of waste of energy in social affairs--indeed, anything and everything that has a tendency to bring on enervationmay be the exciting cause of convulsions in those of a pronouncedly nervous temperament. Cases running on for several years will show mental deterioration. In some there will be developed a decided irritability. If this condition continues to occur, it may be necessary to put such patients under restraint--perhaps in an asylum, People who have epilepsy should not think of getting married.

No treatment is needed in any case, further than diet and hygiene. There is talk at this time of the discovery of the bacillus epilepticus and the removal of a portion of the colon. This belongs to freak surgery, and it will not cure. The surface of the body must be taken care of, the bowels regulated, and then the eating should be specially adapted to the individual case. Those who carry considerable flesh should be kept on fruit morning, noon, and night, and nothing else until the weight is brought down to about an ideal standard; then fruit for one meal, starch and fruit for another, and meat, with cooked and raw vegetables, for a third meal. This is an outline of the diet that such patients should follow. They should be cautioned about eating when feeling uncomfortable. Our golden rule--Rule No. 1--should be observed at all times. When patients with epilepsy persist in eating heartily, there is no hope and the disease will grow worse continually.