From a psychiatric standpoint epilepsy manifests itself by permanent disorders and by paroxysmal accidents.

Permanent Psychic Disorders

These impart to the epileptic personality a peculiar stamp and often lead one to surmise the existence of the disease before knowledge of any seizures is had. We shall consider separately anomalies of disposition and intellectual disorders.

(A) Anomalies Of Disposition

These are often very marked. The following are the principal ones:

(1) Irritability and variability of moods, selfishness, duplicity.

(2) Habitual apathy, sudden impulsive reactions, violent and at times terrible fits of anger.

(3) Lack of consistency between the patient's conduct and his ideas, more rarely abnormal stubbornness and tenacity: "Some celebrated men who are supposed to have been epileptics are more noted for their pertinacity than for the greatness of their conceptions." 1

(4) Morbid religious fanaticism, not constant, but frequent, usually merely ostentatious, with more regard for the rites, ceremonies, and customs, and without influence upon the morality of the patient.

(B) Intellectual Disorders

Epileptics are sometimes, but not often, as claimed by some authors, men of great intelligence. Some hold prominent places in history, in literature, and in the arts: such were Ciesar, Napoleon, Flaubert, and others. Others, though in a more modest sphere, are honorable occupants of offices requiring lucid intelligence and sane judgment. These cases are, however, exceptional. Intellectual inferiority as a rule forms a part of the clinical picture of epilepsy. Often it is congenital, for most epileptics are originally feeble-minded; in other cases it is acquired; the manifestations of epilepsy - convulsions, fainting spells, psychic attacks - exercise a harmful and lasting influence upon the intelligence. When sufficiently marked, the mental deterioration becomes epileptic dementia.

1 Fere. Les epilepsies et les epileptiques, p. 423.

The degree of dementia depends in a measure upon the number and severity of the seizures. "It cannot be doubted that the stupor produced by the major attacks is more marked than that resulting from minor ones; and it is certain, as is admitted by Legrand du Saulle, Voisin, Sommer, etc., that major seizures occurring at frequent intervals much more rapidly lead to dementia than do incomplete seizures." l

The two essential features of epileptic dementia are: (1) its irregularly progressive development, with aggravations following the seizures; (2) its being to a certain extent remittent, the apparent deterioration becoming less marked as the intervals between attacks become longer.