Epilepsy, Hysteria, and Neurasthenia | Page 7

complaint.
A few victims are attacked only after excessive alcoholic or sexual indulgence, some women only during their menses, while other women are free from attacks during pregnancy, which state, however (contrary to popular belief), commonly aggravates the trouble. Victims may be free from attacks during the duration of, and for some time after, an infectious disease; while Spratling says that a consumptive epileptic may have no fits for months, or even years.
Some epileptics are normal in appearance, but many show signs of degeneration. This is common in the insane, but less frequent and pronounced in neurasthenics. An abnormal shape of the head or curvature of the skull, a high, arched palate, peculiarly-shaped ears, unusually large hands and feet, irregular teeth from narrow jaws, a small mouth, unequal length and size of the limbs, a projecting occiput, and poor physical development may be noted.
These are most pronounced in intractable cases, in whom mental peculiarities are most frequently seen--either dullness, stupidity and ungovernable temper, or very marked talent in one direction with as marked an incapacity in others. In all epileptics, the pupils of the eye are larger than normal, and, after contracting to bright light soon enlarge again.
The facial expression of most epileptics indicates abnormal mentality. When the seizures have been so frequent and severe as to cause mental decay, the actions are awkward, and the gait slouching and irregular. Progressive poor memory is one of the first signs of intellectual damage consequent upon severe epilepsy.
Though the disease may occur at any age, most cases occur before the age of twenty, there being good reason to look for other causes (often syphilis) in cases which occur after that age. Of 1,450 of Gowers' cases, 30 per cent commenced before the age of ten; 75 per cent before twenty. In Starr's 2,000 cases, 68 per cent commenced before the patient was twenty-one.
According to Turner, the first epoch is from birth to the age of six, during which 25 per cent of all cases commence, usually associated with mental backwardness, and some due to organic brain trouble. The second epoch is ten to twenty-two, the time of puberty and adolescence, during which time no less than 54 per cent of all cases commence. This is, par excellence, the age of onset of genuine epilepsy, the mean age of maximum onset being fourteen in men and sixteen in women. The remaining 21 per cent of cases occur after the age of twenty-two.
In 430 cases of epilepsy in children, Osler found that 230 were attacked before they reached the age of five, 100 between five and ten, and 100 between ten and fifteen.
Epilepsy, then, is a disease of early youth, coming on when the development and growth of the nervous and reproductive systems is taking place. During this period, causes, insignificant for stable people, may light up the disease in those of unstable, nervous constitution, a fact which explains the importance of training the child.
Both sexes are attacked. If we consider only cases of true idiopathic epilepsy female patients are probably in excess, but in epilepsy in adults, from all causes, males predominate. In females, the menopause may arrest the disease.
In days gone by, epilepsy more rarely commenced after the age of twenty, but in these days of nerve stress it commences more frequently than formerly in people of mature age. A victim who has a fit for the first time after the age of twenty, however, should consult a nerve specialist immediately.
In its early stages there are no changes of the brain due to, or the cause of, epilepsy, but in long-standing, severe cases, well-marked, morbid changes may be found. These are the effects, not the cause, of the disease, and they vary in intensity according to the manner of death and the length and severity of the malady. They probably cause the mental decay and slouching gait mentioned before.
Fits may suddenly cease for a long time, but they usually recur, and most patients have them more or less regularly through life.
The fact that recovery is rare should not be hidden from patients and friends. Perhaps 8 per cent of all classes recover--and "recovery" may only be a long interval--but 4 per cent of these are Jacksonian, syphilitic or accident cases. Only one victim in every thirty recovers from true epilepsy; and these are very mild cases, in which the fits are infrequent, there is no mental impairment, and bromides are well borne. The earlier the onset, the more severe and frequent the attacks, the deeper the coma, and the worse the mental decay, the poorer the outlook.
Cure is exceptional, but by vigorous treatment the severity of the malady may be much abated. Petit mal is no more hopeful than _grand mal_; less so in cases with severe giddiness; in all cases, the better