Epilepsy (Gr. from to seize upon), a disease characterized by sudden and temporary seizures of unconsciousness, accompanied by convulsions. This is one of the most horrible diseases that afflict mankind, and it is not surprising that in ignorant ages, in Rome, in Egypt, and elsewhere, epileptics were considered as having excited the anger of the gods, or were worshipped as possessing supernatural powers. This was due to the violence and extraordinary force developed by the muscles in epileptic convulsions; the screaming, the changes in color, the contortions of the face, and the biting of the tongue, followed by a comatose state and afterward by a degree of mental alienation. There are so many varieties of epilepsy that it is impossible to give a definition of the disease that will apply to them all. In most cases it is characterized by convulsions and loss of consciousness, occurring at longer or shorter intervals, during which the patient is almost in good health. The absence of fever in epileptics serves to distinguish their affection from meningitis and other inflammations accompanied by convulsions. The complete loss of consciousness also distinguishes epilepsy from hysteria.
As in most nervous diseases, a hereditary tendency is among the most frequent predisposing causes of epilepsy. Epilepsy often appears in the offspring of persons who have had various other nervous complaints. Bouchet and Cazauviehl say that out of 130 epileptics 30 were descendants of persons who had been either epileptic, insane, paralytic, apoplectic, or hysteric. There is no doubt that women are much more frequently attacked by epilepsy than men. We find by a comparison of the statistics given by several English and French authorities, that the most frequent periods at which epilepsy begins are early infancy and the age of puberty. It often appears also in very old age; Delasiauve remarked that out of 285 epileptics the disease began in 10 when they were from 60 to 80 years old. In fact, no age escapes. As regards climate, nothing very positive has been established, but it seems probable that the disease is more frequent in hot and in very cold than in temperate climates. Herpin and others say that epilepsy is more common in persons of low stature; but even if this be true, Herpin is wrong in considering shortness of stature a predisposing cause of the disease, as in many of the cases on which he grounds his view it is partly the influence of epilepsy that has prevented the development of the body.
Various malformations of the body, and especially of the cranium, are certainly among the most frequent predisposing causes. Weak constitutions, as proved by Esquirol and Dr. C. B. Radcliffe, are favorable to the production of epilepsy. Among other predisposing causes are dentition, the first appearance and the cessation of menstruation, onanism, and the abuse of alcoholic drinks. Almost all kinds of diseases may produce epilepsy, but among the principal we must place those affections in which the blood becomes altered or diminished, and organic affections of the membranes of the cerebro-spinal axis and of certain parts of this nervous centre. Another very powerful cause, the influence of which has been demonstrated by Marshall Hall, Kussmaul, Jenner, and Brown-Sequard, is excessive loss of blood. Pregnancy, parturition, and menstruation frequently cause epilepsy. A tumor on a nerve, or any cause of irritation on the trunk of the terminal part of any sensitive nerve, and especially in the skin or mucous membrane, very often produces it. A wound, a burn, worms in the bowels or elsewhere, stone in the bladder or in other places, a foreign body in the ear, etc, are known to have caused epilepsy.
It is quite certain that great mental excitement has originated it in many cases, but it seems probable that the disease was not introduced by those causes, but was only brought by them to manifest itself. - When a complete fit is about to take place, it is usually preceded by some sensation or some change in the mind of the patient. If a sensation precedes the fit, it comes most frequently from some part of the skin, and especially from that of the fingers or toes. This sensation is well known under the name of aura epileptica. There is as much variation in the kind and the intensity of the sensation as in its point of starting. Most frequently the aura is a sensation of cold, of burning, or that kind of sensation produced by a draft of cold air on a limited part of the body. Sometimes the aura starts from the eye or the ear, and then a flash of light or some other sensation comes from the retina, or peculiar sounds are heard. Some epileptics become gay, others mournful, when they are about to have a fit; in others the attack is announced by some change in the digestive functions. A complete attack usually begins with an extreme paleness of the face, and at the same time or nearly so there are contractions of several muscles of the face, the eye, and the neck.
Observers do not agree as regards the first manifestation of a fit, probably because the seizure does not always begin with the same phenomenon. Not only have we known the first symptom not to be the same in different epileptics, but in the same one we have seen differences in three different attacks. Many physicians think the scream is the first symptom. It often is, but the paleness of the face usually precedes it. Some epileptics do not scream. As soon as these symptoms have appeared, a rigid tetanic or at least tonic spasm takes place in the limbs, and the patient falls. Respiration is suspended, and the face becomes quite injected with black blood, and assumes a hideous aspect both from the spasms of its muscles and the blackish or bluish hue. Sometimes a momentary relaxation is then observed in the limbs; but almost at once clonic convulsions occur everywhere in the trunk, the limbs, the face, and often in the various internal organs of the bladder, the bowels, and even in the uterus. The mouth then ejects a frothy saliva, often reddened with blood from the bitten tongue.
The respiratory muscles, after the first spasms which produce the scream and suffocation, causing a gurgling or hissing sound, become relaxed, and then those employed in inspiration contract, and almost as soon as air has reached the lungs the convulsions cease or notably diminish. Ordinarily the fit is over in a few minutes; but it is not unfrequently the case that after a general relaxation another seizure comes on, and sometimes many occur with very shorty intermissions. During the whole time the fit lasts the patient is deprived of consciousness, and when he recovers he remembers nothing that has taken place in the mean time. In some cases the seizure is followed by a prolonged coma, ending sometimes in death. When the patient recovers from a fit, even if it has not been very severe, he usually feels fatigued and suffers from headache. Fortunately he soon falls asleep, and ordinarily is almost as well as usual when he wakes, except that the headache and the fatigue still exist, though much diminished. When many fits have taken place, even at somewhat long intervals, such as several weeks, mental derangement often supervenes, and in this way epilepsy leads to insanity.
In some cases the fits recur at regular periods; in others they return with every return of the circumstances which seem to have caused the first, such as menstruation, pregnancy, the influence of certain seasons, etc. There is seldom perfect regularity in the length of the intervals between the fits, and they come every day, every week, every month, etc, at irregular hours. Many patients have very different intervals between their successive fits. Some have many fits a day, others one every six months, or every year. Dela-siauve mentions a case in which the number of fits was 2,500 in a month. But the greater the number of fits, the less violent they generally are. - In a complete fit of epilepsy there are two distinct features: 1, the loss of consciousness; 2, the muscular convulsions. Each of these may exist alone. In the case of a seizure consisting only in the loss of consciousness without convulsions, we have the so-called epileptic vertigo, which is a form of epilepsy that frequently exists alone, and also coexists often with the form of the disease in which the attack is complete. In this last case the patient sometimes has a complete seizure, sometimes only an attack of vertigo.
Whether vertigo exists alone or coexists with complete attacks, it is very dangerous, not for the life of the patient, but because fits of simple vertigo lead more frequently to insanity than complete fits of epilepsy. The cases of epileptiform convulsions without loss of consciousness are not so frequent as the cases of simple vertigo. They are particularly produced by injuries to the nerves or to the spinal cord. - The nature of epilepsy, the material and dynamical conditions of the parts which are affected in the animal organism, have been greatly illustrated by the researches of modern physiologists and practitioners. Dr. Marshall Hall thought its seat to be chiefly in the medulla oblongata, and that its nature consisted in an increased reflex power, at least in the beginning of the disease, and also that the convulsions were the results of the asphyxia caused by the closure of the larynx (laryngismus). This theory is in opposition to several facts. In the first place, although laryngismus almost always exists and certainly concurs in the production of asphyxia, and in so doing generates convulsions, it cannot be considered the cause of convulsions, as it does not always exist, and as there is one kind of convulsions (the tonic) which precedes the asphyxia.
Besides, there are more powerful causes of asphyxia in the condition of the circulation in the brain and the spasm of the muscles of the chest. Then, as regards the increased reflex power, Dr. Hall acknowledges that this power is diminished in persons who have been epileptic for some time. We cannot admit therefore that the disease consists in the increase of this power. Another theory has been proposed by Dr. Brown-Se-quard. Guided by experiments on animals, in which he produces epilepsy, he has found that the reflex power is composed of two distinct powers, one of which he calls the reflex force and the other the reflex excitability. He has found that the reflex force may be very much diminished while the reflex excitability is very much increased. This last power is the power of impressibility of the cerebro-spinal axis; in epileptics this impressibility is very much augmented. The slightest excitations may produce reflex actions in them. In the beginning of epilepsy, usually the other reflex power, which is the force manifested in the reflex actions of the cerebro-spinal axis, is increased; but after a time this force diminishes, and in most cases it becomes less, and even much less, than in healthy people.
The nature of epilepsy seems to consist in an increase of the impressibility, or in other words of the reflex excitability of certain parts of the cerebro-spinal axis. In most cases of epilepsy these parts are the medulla oblongata and the neighboring parts of the encephalon and of the spinal cord. But the seat is not constant, and may be sometimes limited to the oblong medulla or extended to other parts of the cerebro-spinal axis. Dr. Brown-Sequard has tried to explain the mysterious phenomenon of loss of consciousness. It seemed very strange that at the same time that certain parts of the encephalon were acting with great energy, another part should be completely deprived of action. This, according to him, is very simple. The blood vessels of that part of the brain which is the seat of consciousness and of the mental faculties receive nerves from the medulla oblongata and the spinal cord; these blood vessels when they are excited contract and expel the blood they normally contain, and it is known that all the functions of that part of the brain cease when they do not receive blood.
When the excitation that exists in the beginning of a fit acts upon the medulla oblongata and its neighborhood, it produces at the same time the contraction of the blood vessels of that part of the brain which we have mentioned, and a convulsive contraction of the muscles of the face, the eye, the neck, the larynx, etc, all parts receiving nerves from the same source as these blood vessels. In this way the loss of consciousness is explained. The following table from Dr. Brown-Sequard's work on epilepsy shows how the principal phenomena are generated:
1. Starting of an excitation from a sensitive or an excitable part of the nervous system.
2. Contraction of the blood vessels of the brain proper.
3. Accumulation of blood at the base of the encephalon, due to its expulsion from the brain proper, etc.
4. Spasm of larynx and of expiratory muscles.
6. Exhaustion of nervous power, except of the part of the nervous centres employed in respiration.
7. Return of respiration.
1. Contraction of the blood vessels of the brain proper, and contraction of some muscles, by a reflex action from the central seat of the disease.
2. Loss of consciousness.
3. Spasm of the larynx and of the muscles employed in expiration.
4. Cry and asphyxia.
5. General clonic convulsions.
6. Cessation of the convulsions and return of respiration.
7. Return of consciousness.
- The first thing to be done for an epileptic is to find out the cause of the disease, and to try to get rid of that cause if it still exists. Very often epilepsy depends upon some external cause of irritation which may easily be removed; it is of the greatest importance to discover if there is anywhere such an irritation, and as the patient may not be aware of its existence, it is necessary to look for it everywhere. Of the various modes of treatment, the most powerful are those means of exciting the skin which most readily produce a change in the nutrition of the encephalon and spinal cord. All physicians know what these means are. One of the most efficacious remedies is belladonna. Patients and their families should remember that the rules of hygiene must be followed by epileptics much more closely than by those afflicted with almost any other disease.