Epilepsy, Hysteria, and Neurasthenia | Page 7

necessarily lead a semi-invalid life, often cut off from
wholesome work and from the pleasures of life, and become
hypersensitive, timid, impulsive, forgetful, irritable, incapable of
concentration, suspicious, show evidences of a weakened mind, have
few interests, and are difficult to manage.
About 10 per cent--the very severe cases--go on to insanity; either
temporary attacks of mania, calling for restraint, or permanent epileptic
dementia with progressive loss of mind. Some victims are accidentally
killed in, or die as a result of a fit; about 25 per cent--severe cases
again--die in status epilepticus, but the majority after being sufferers
throughout life are finally carried off by some other disease.
There are many exceptions to this general course. Some patients have
attacks very infrequently, and are possessed of brilliant talent, though
apt to be eccentric. Others may have a number of seizures in youth, and
then "outgrow" the 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