Part 13

The duration of the attack may be from one to four minutes, or exceptionally ten or fifteen, after which the muscles relax, the twitching ceases, the horse raises his head, extends his fore limbs and finally rises.

After rising some are dull and stupid for an hour or so, and may continue to perspire, some move the limbs, jaws or head automatically, turn in a circle, or seek seclusion and darkness, while some take at once to eating and seem as if nothing had happened.

In partial or localized epilepsy the spasms are confined to a limited group of muscles like those of the jaws, neck, or fore limbs. These may alternately contract and relax, or they may remain rigid for a minute or less, the mouth being held open or firmly closed with grinding of the teeth, the eyes rolled backward and upward, or affected with strabismus, the face drawn and distorted, the head turned to one side or downward, or the limbs fixed and immovable.

At the conclusion of an attack it is not uncommon to see a discharge of urine or fæces, or in stallions, of semen.

The horse often contracts a fear of the place where the attack occurred, and this contributes, with the re-appearance of the former object of dread (car, locomotive, rifles, cannon, etc.) to precipitate a new attack if he is compelled to go to such a place.

Symptoms in =Cattle=. In cattle the animal is attacked without premonition, bellows, breathes hard and with effort, has dilatation of the nostrils, and squinting or rolling upward and backward of the eyes and falls to the ground rigid and trembling. There may be violent succussions of the limbs, head or neck, movements of the jaws, grinding of the teeth, and the appearance of frothy saliva and elements of food about the lips. The beats of the heart are violent, the pulse slow and small, and sometimes intermittent. Involuntary micturition, defecation, or discharge of semen may occur. In slight cases one or more of these symptoms may be absent, and the victim may not even fall to the ground but support himself against a wall or other object.

The duration of the attack may be from one to five minutes, rarely more, and there is often a slow and progressive subsidence of the spasms. When recovered the animal may get up and go to eating or rumination as in health.

Symptoms in =Sheep=. In sheep the attack is sudden. The animal ceases eating or stops in its walking, and after turning or other involuntary movement falls to the ground, head extended, mouth open, eyes rolling or squinting, and with rigidity or twitching of the muscles of the neck or limbs. There is the same loss of sensation, frothing from the mouth, and grinding of the teeth as in the larger animals. The attack may last 40 to 50 seconds.

Symptoms in =Swine=. In pigs a state of discomfort and restlessness often marks the approach of an attack, referable probably to the digestive disturbance or to parasites which furnish the occasion of the disease. Uneasy, wandering movements, jerkings of head or limbs, rolling of the eyes, and champing of the jaws may first appear. Then the animal falls, extending its limbs and head, with open mouth, retracted lips, and a free flow of saliva. Trembling and jerking of the head, neck and limbs, hurried, short, difficult breathing, and complete loss of sensation may be noted. Discharges of urine, semen, and prostatic fluid are not uncommon. The attack usually lasts 2 or 3 minutes, and exceptionally 10 to 15. In the shorter seizures, frequent repetition is not uncommon, Delafond having observed 5 or 6 attacks in the course of an hour.

Symptoms in =Dogs=. The attack is sudden and unheralded by prodromata. The animal stops, trembles, cries plaintively and falls; he may manage to rise or to do so in part but instantly falls anew. The limbs stiffen, tremble or twitch, the head is extended or flexed, or jerked, violently striking the ground, the mouth open, with abundant saliva, or firmly closed though the tongue may be between the teeth. The trunk may be firm and rigid or alternately twisted in one direction or the other. The eyes roll or squint, and the breathing is stertorous and difficult. Insensibility is complete. Toward the end of the attack there may be a discharge of urine, fæces or semen, the stools often containing worms. The body is often wet with perspiration during or after an attack.

The attack usually lasts for two or three minutes, then the convulsions gradually lessen in intensity and finally cease, the dog raises his head, opens his eyes, and gazes inquiringly around. Then he gets on his feet shakes himself and may at once resume his customary habits. In other cases the restoration is less sudden. The dog remains for 30 to 60 minutes dull and stupid, or seems to have little power of control over its muscles and staggers as if intoxicated, or as if the muscles were benumbed. It may drop on its knees and then fall with the head on the ground and repeat this several times. In other cases the dog wanders around, or trots off and may snap at any one interfering with him, so that the case is often mistaken for one of rabies. Finally the animal may remain prostrate and fall into a deep sleep marked by stertorous breathing.

Diagnosis. The diagnosis of epilepsy is usually easy. The suddenness of the attack, the loss of consciousness, the muscular spasms, the complete temporary recovery and the tendency to recur, form a toute ensemble, which is pathognomonic. The danger of confounding this with other nervous disorders is on the whole greatest in the slight cases in which the symptoms are less typical.

From =Syncope= it is easily distinguished by the spasms which are not present in syncope.

From =eclampsia= it is not so easy to diagnose, but the line between eclampsia and epilepsy has not been accurately drawn, and some have even shown a disposition to drop eclampsia from medical nomenclature. Eclampsia may be defined as general convulsions dependent on some eccentric irritation, and which do not recur after such irritation has been removed. This would remove from the category of epileptic attacks the cases of convulsions in which the attacks were due to intestinal or nasal parasites, dentition irritation, tumors pressing on nerves, canine distemper and other infectious diseases. So far the distinction might be made by the diagnosis of the particular disease on which the convulsions depend. There remains however a class of cases in which the centric nervous disorder on which the epileptic seizure depends is present, and also the peripheral source of irritation (worms, etc.). In such a case the presence of the worms or other eccentric source of irritation, even if added to the fact that this was the immediate exciting cause of the epileptic explosion, could not do away with the fact that the essential conditions of epilepsy are permanently present in the nervous centres. The difficulty therefore of making an accurate differential diagnosis, resides largely in the impossibility of drawing a definite line of pathological separation between eclampsia and epilepsy.

From =Vertigo= epilepsy is distinguished by the absence in the former of marked spasmodic contractions. It is only in the milder forms of epilepsy those in which the spasmodic action is so slight as to be overlooked, that this disease can be confounded with vertigo.

From =Thrombosis= or =embolism= of the iliac or femoral arteries epilepsy is easily distinguished by the absence of exercise as the essential cause in the development of the latter. In thrombosis on the other hand, the loss of control over the hind limbs is developed at will by active motion (walking, trotting). In thrombosis too the absence of pulsation at the fetlocks or at any point below the seat of obstruction is conclusive.

=Question of Soundness and Jurisprudence.= Manifestly a horse or bull subject to attacks of epilepsy is not sound. It is moreover a disease, the symptoms of which are only shown for a very short period at one time, after a long interval of apparently perfect health. It is, therefore, a disease against which a purchaser cannot be expected to protect himself and he should have the right to annul the sale and return the animal in case the infirmity should appear within a reasonable period after purchase. This is provided for in the laws of different countries of Europe, thus in Wurtenberg, Baden and Hesse, a purchased animal may be returned within 28 days; in France within 30 days, and in Bavaria within 40 days. The greatest difficulty arises from the frequent impossibility of obtaining expert testimony on a seizure which is likely to occur at any moment, without premonition, and in which the testimony of a non-expert may easily be misleading. It seems as if complaint having been made within the specified legal time, an extension of guarantee should be given by the court, the animal to be meanwhile kept under the supervision of a veterinarian.

Another question has arisen as to the position of an animal suffering from reflex epilepsy. If the attacks are caused by intestinal worms or nasal acarina which are easily removed, it is quite evident that this cannot be considered as a permanent unsoundness, and one for which a contract of sale can be justly annulled. But on the other hand, while the eccentric source of irritation which is easily curable may have been the active agent in developing the seizures, it may be none the less true that the central infirmity which determines the abnormal susceptibility, to excessive generation and epileptic explosion of nervous force, may also be present and the animal cannot be considered as sound until a sufficient length of time has elapsed after the removal of the peripheral irritation and no new seizure has taken place.

Treatment of Symptomatic Epilepsy. In cases due to an eccentric irritant the first step must be the removal of such irritant. In case of intestinal worms the various vermicides and tæniacides must be resorted to. (See Intestinal Parasites). For the linguatula tænioides the injection of benzine or tobacco water into the nose, or into the sinuses, with or without trephining may be resorted to. In diseased teeth extraction or filling may be demanded. In dentition irritation, lancing of the gums. In all other cases in which a peripheral nervous irritation can be traced every available means should be taken to remove it.

Treatment of Central Epilepsy. Bearing in mind that peripheral irritation is a frequent exciting cause of a seizure, too much care cannot be given to the conservation of the general health and especially to make the diet wholesome in quantity, quality and time of feeding and watering, and to guard against constipation and indigestion. In dogs a too stimulating meat diet is to be avoided.

The medicinal agents employed have been mainly such as are sedative, or tonic to the nervous system. Valerian was long extolled as a valuable remedy (Gohier, Delafond, Delwart), and this has been improved upon more lately by substituting valerianate of zinc. Belladonna and its alkaloid atropia have been strongly advocated (Tisserant, Bernard, Williams, Friedberger) and it has the recommendation that it causes vaso-motor contraction and tends to lessen cerebral congestion. Hyoscine or duboisine may be used as a substitute. Cyanide of iron has been lauded by Jourdier and Tabourin, as far superior to valerian. Of late years the nerve tonics, zinc compounds (oxide, sulphate, chloride) and silver salts (nitrate) and arsenic have been used, often with excellent results. Borax strongly recommended for man (1 to 1¾ drachm daily) by Pastena is worthy of a trial for dogs. It is given largely diluted in syrup to avoid gastric irritation.

Of all agents employed up to the present the bromides still claim a foremost place. They should be given in a large dose, on an empty stomach and at such a time as to occupy the system at the hour when the seizure is expected to recur. Thus for morning attacks the dose may be given at night, while for night attacks it may be given in the afternoon. Müller uses sodium bromide in the dog as least liable to disturb the stomach, while Peterson, for man, advises the potassium salt for the same reason. For man, McLane Hamilton advocates a combination of the sodium and ammonium salts, Eulenberg adds the potassium compound, while Berkley uses strontium bromide, and Bourneville camphor monobromide.

Given at night in full dose (30 grs. for dog) the bromides tend to secure a quiet sleep, with brain rest and recuperation. If beneficial they should be repeated daily until a cure or other sign of bromism appears. This may be somewhat checked by arsenic or chloral hydrate.

Wesley Mills finds potassium iodide useful in some dogs when bromides fail. Bromohydrate is advocated by Müller. Flechsig and others have had excellent results in man from the opium bromide treatment. Full doses of opium are given three times a day for six weeks, when they are replaced by full doses of bromides four times a day.

Improvement should be shown in the shortening of the convulsions and the lengthening of the intervals between them. Should the bromides fail in this, resort may be had to other treatment.

Toulouse, Clark and others find that privation of salt, in man, allows the bromine salt to replace the chlorine one in the tissues, and the hydrobromic acid the hydrochloric in the gastric juice, and in this way the bromine can be introduced safely in larger amount into the tissues and is longer retained, though given in half the doses.

A most important element in the treatment is a vegetable diet with or without milk, to obviate excessive production of uric acid. Anything which will disagree and produce gastric or intestinal fermentations with toxins must be carefully guarded against and these will differ in different individuals.

Stallions and other excitable males, and females may often be cured by castration. Patients should be very carefully guarded against all sources of excitement, reports of guns, sight of locomotives or automobiles, waving flags, instrumental music, sudden exposure to sunshine or other bright light, reflection from water, snow, or ice, the contrast of dark shadows, as of trees, alternating with bright light, etc. Dogs, becoming excited at a show, may have a convulsion if not removed, and much more so in presence of another dog in a fit.