Part 4

From these figures we find that in 34.4 per cent. of the cases of epilepsia gravior there are no special symptoms announcing the seizure, which takes place without warning of any kind; and it is especially in such cases that patients in falling, seriously injure themselves. In 65.5 per cent. there are premonitory symptoms of some kind, which indicate often many hours before the approach of an attack. Of these last 47.4 per cent. are of a general character, and in no less than 72.8 per cent. is there a distinct special aura, which in 25.4 per cent. alone precede the attack, the remainder being associated with the general premonitory symptoms.

Symptoms of the Attack.--In the cases of epilepsia gravior there were complete loss of consciousness with convulsions, lasting from five to ten minutes, and occurring at intervals, leaving no question as to the true nature of the disease, and all doubtful examples have been excluded from this collection. Attempts were made to form an analysis of the different symptoms constituting the paroxysm, but with indifferent success, and these are not here reproduced, because they are not sufficiently accurate for scientific purposes. The patient himself can give no account of what takes place. The friends around do not look upon the phenomena of the attack with the critical and philosophic eye of the physician; hence any information from them as to the part convulsed, the colour of the skin, the duration of the seizure, and so on, is extremely vague and untrustworthy. The number of cases personally observed actually during attacks is too limited to warrant any generalizations. There is, however, one important point which can be accurately demonstrated--namely, whether or not the tongue is bitten, and in the cases under observation

The tongue was bitten in 68.8 per cent. The tongue was not bitten in 31.2 per cent.

Frequency of Attacks.--Only a general average of the number of attacks can be made; and in the present series the following gives an idea of the frequency of seizures in different individuals.

Average of one or more attacks per day in 8.8 per cent. Average of one or more attacks per week in 31.1 per cent. Average of one or more attacks per month in 32.2 per cent. Average of one or more attacks per year in 15.5 per cent. At longer or more irregular intervals in 12.2 per cent.

This roughly indicates that, in the majority of cases, attacks of epilepsia gravior occur one or more times weekly or monthly. Under the last series, of attacks taking place at longer and more irregular intervals than a year, are included those cases where a few only have occurred during the lifetime of the patients.

Regularity of Attacks.--Many epileptics are attacked at regular intervals, sometimes on the same day or even hour; while others are afflicted at any time, day or night. The following indicate the proportion:--

Attacks occur at regular intervals in 21.1 per cent. Attacks occur at irregular intervals in 78.8 per cent.

Time of Attack.--The following particulars alone could be definitely ascertained:--

Attacks only during sleep in 8.8 per cent. Attacks only during day while awake in 8.8 per cent. Attacks only during early morning in 15.5 per cent. Attacks at no particular time in 55.4 per cent.

The chief feature of this observation is that in 15.5 per cent. of cases of E. Gravior the attacks always took place immediately after the patients had wakened in the morning, and this is probably due to the sudden alteration of the cerebral circulation from the sleeping to the wakeful state.

Symptoms immediately after the Attack.--The moment the attack is over sometimes the patient is in his usual condition, and feels no ill effects from the paroxysm. More commonly, however, he suffers from various symptoms, the chief of which, and their relative frequency, is as follows:--

Return to usual condition in 12.2 per cent. Drowsy in 66.6 per cent. Confused in 14.4 per cent. Stupid in 13.3 per cent. Irritable in 14.4 per cent. Excitable in 3.3 per cent. Vertigo in 13.3 per cent. Headache in 41.1 per cent.

The above conditions may last from an hour to several days.

Present condition, or state between the Attacks.--It is impossible to enter minutely into the actual physical and mental health of all the epileptic cases under notice, but the following statement gives a sketch of some of the more important conditions associated with the disease, and the frequency with which they occur. In the inter-paroxysmal state the condition of the patients were--

Healthy in every respect in 17.7 per cent. With some abnormal peculiarity in 82.2 per cent.

General health good in 75.5 per cent. General health impaired in 24.4 per cent.

Robust in 66.6 per cent. Not robust in 33.3 per cent.

Intelligence intact in 74.4 per cent. Intelligence impaired in 25.5 per cent.

Loss of memory in 58.8 per cent. No loss of memory in 41.1 per cent.

Stupid in 16.6 per cent. Dull in 31.1 per cent. Irritable in 25.4 per cent. Frequent headaches in 41.1 per cent. Frequent vertigo in 22.2 per cent. Nervous in 21.1 per cent. Special diseases in 21.1 per cent.

Of the 21.1 per cent. under the heading of special diseases, there were--

Hemiplegia in 6.6 per cent. Paralysis of seventh nerve in 1.1 per cent. Impediment of speech in 1.1 per cent. Cicatrix over sciatic nerve in 1.1 per cent. Idiot in 1.1 per cent. Anæmia in 5.5 per cent. Phthisis in 2.2 per cent. Confirmed dyspepsia in 1.1 per cent.

From these details it is evident that epilepsy is not of necessity associated with impairment of the physical or mental health. On the contrary, we find that in 17.7 per cent. of the patients there was apparently no flaw of any kind in their constitutions, which were absolutely normal, with the exception of the periodic seizures. In no less than 75.5 per cent. was the general health good, and in 66.6 per cent. the patients were robust and vigorous. At the same time the health was markedly impaired in 24.4 per cent., and the sufferers were of delicate or weak habit in 33.3 per cent. The main fact, however, to be observed is that, in the majority of cases of epilepsy, the general health and vigour of the patient is not deteriorated. In the same way, the intellectual capacities are not of necessity affected. In 74.4 per cent. the intelligence is recorded as not seriously impaired; and in 41.1 per cent. the memory as good. On the other hand, the mental faculties were markedly deficient in 25.5 per cent.; the patients were dull and slow in 31.1 per cent.; and in more than half, or 58.8 per cent., was there evidence of loss of memory. Another frequent symptom is repeated and constant headache, which, in the present series of cases, existed in 41.1 per cent.

2.--EPILEPSIA MITIOR.

This occurred altogether in 38 per cent. of the total number of cases. In these it occurred--

By itself in 26.3 per cent. Associated with E. Gravior in 73.6 per cent.

In all, the usual characteristics of the petit mal presented themselves; there being temporary loss of consciousness, sometimes with slight spasms, but without true convulsion, biting of the tongue, &c.