An attack of epileptic delirium lasts from a few minutes to several days. It may be reduced to a single automatic act. Like the other manifestations of epilepsy, it may be produced always by the same external influence and assume the same form each time. This is of course far from being always the case.
The above is a description of the most common, one may say classical, form of epileptic delirium. Another form is occasionally met with in which ideas of grandeur occur in place of the painful delusions; these ideas often assume a mystic character and are associated with a state of euphoria which may reach the intensity of ecstasy.
The diagnosis is very easy when these phenomena appear in an old epileptic; it becomes very difficult, however, when the epilepsy is "masked, or atypical in its course."1
There is no pathognomonic sign of epileptic delirium excepting, perhaps, the stupor which follows it and the importance of which is justly insisted upon by Samt and Moeli.2 However, this stupor may be so slight as to escape the observation of those witnessing the attack. The previous history of the patient may contain nothing to aid in the diagnosis because delirium sometimes constitutes the first manifestation of epilepsy. Only upon the entire symptom complex together with the previous history of the patient can the diagnosis of epileptic delirium or of any other epileptic manifestation be established. We may distinguish:
1 Magnan. Loc. cit., p. 2.
2 Allg. Zeitsch. f. Psychiat., 1900, Nos. 2 and 3.
Delirious attacks of general paralysis, which may resemble epileptic delirium, by the clinical history, the special physical signs of this affection, and findings in the cerebro-spinal fluid.
Attacks of catatonic excitement by the relative conservation of lucidity.
Finally, in epilepsy one may meet with attacks of so-called epileptic mania which at times simulate closely the manic-depressive psychoses. However, in these attacks flight of ideas is much less pronounced, as a rule, and the morbid ideas are much more firmly fixed and much more monotonous.1
Several authors, Krafft-Ebing among them, have described under the name of transitory delirium, or transitory mania, very brief, non-recurring delirious attacks which they consider as a distinct morbid entity. The similarity between these attacks and those of epileptic delirium is such that most psychiatrists consider them as being of epileptic origin, at least in the great majority of cases. This opinion is held notably by Schwartz,2 Regis,3 and Vallon.4 According to these authors the cases of transitory delirium which are not of epileptic origin are attributable to some infectious disease, alcoholism, etc. In the clinic only a close study of the antecedents of a given case enables one to decide to which of these causes the attack is due.
1 Heilbronner. Ueber epileptische Manie nebst Bemerkungen iiber Ideenflucht. Monatsch. f. Psychiat. u. Neurol., 1902, Nos. 3 and 4.
2 Schwartz. Mania transitoria. Allg. Zeits. f. Psychiat., 1891.
3 Regis. Manuel de maladies mentales.
4 Vallon. Rapport au Congres d'Angers, 1898.