Epilepsy, Hysteria, and Neurasthenia | Page 8

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 the
physical condition and digestive powers of the patient, the brighter the
outlook.
To sum up, epilepsy is a chronic abnormality of the higher nervous
system, characterized by periodic attacks of alteration of consciousness,

often accompanied by spasms of varying violence, affecting primarily
the brain and secondarily the body, based on an abnormal readiness for
action of the motor cells, occurring in persons with congenital nerve
weakness, and leading to mental decay of various types and degrees of
severity.
* * * * *

CHAPTER IV
CAUSES OF EPILEPSY
"Find out the cause of this effect, Or rather say, the cause of this defect,
For this effect defective comes by cause." "Hamlet," Act II.
THE MECHANISM OF THE FIT
The brain consists of cells of grey matter, grouped together to form
centres for thought, action or sensation, and white matter, consisting of
nerve strands, which act as lines of communication between different
parts of brain and body. The wrinkled surface (_cortex_) of the brain, is
covered with grey matter, which dips into the fissures. There are also
islands of grey matter embedded in the white.
The front part of the brain is supposed, with some probability, to be the
seat of intelligence, while a ribbon three inches wide stretched over the
head from ear to ear would roughly cover the Rolandic area, in which
are contained the motor cells through which impulse is translated to
action. These motor cells are controlled by inhibitory cells, which act
as brakes and release nerve energy in a gentle stream; otherwise our
movements would be convulsive in their violence, and life would be
impossible through inability usefully to direct our energy.
That is how inhibition acts physically; mentally it is the power to
restrain impulses until reason has suggested the wisest course.

Irritation of the cortex, especially the motor area, causes convulsions,
and experiment has shown that epilepsy may be due to a disease or
instability of certain inhibitory cells of the cortex. The motor cells of
epileptics are restrained, with some difficulty, by these cells in normal
times. When irritation from any cause throws additional strain on the
motor cells, the defective brakes fail, and the uncontrolled energy,
instead of flowing in a gentle stream through the usual channels, bursts
forth in a tidal wave through other areas of the brain, causes
unconsciousness, and exhausts itself in those violent convulsions of the
limbs which we term a fit.
The Primary Cause of epilepsy is an inherent instability of the nervous
system.
Secondary Causes are factors which cause the first fit in a person with
predisposing nervous instability; later, the brain gets the fit habit, and
attacks recur independently of the secondary cause. In most cases no
secondary causes can be discovered, and the disease is then termed
idiopathic, for want of an explanation.
Injuries to the brain may cause epilepsy, and many cases date from
birth, a difficult labour having caused a minute injury to the brain.
Some accident is often wrongly alleged as the cause of fits, for most
victims come of a bad stock, and when the first fit occurs, their
relatives recollect an injury or a fright in the past, which is said to be
the cause.
Great fright may cause epilepsy, as in the case of a nervous girl whose
brother entered her room, covered with a sheet, as a "ghost", a "joke"
that was followed by a fit within an hour.
Sunstroke may cause fits, and a few cases follow infectious diseases.
Alcoholism is a strong secondary factor, fits often occurring during a
drinking-bout and in topers, but in many cases, drunkenness, instead of
being the cause, is only the result of a lack of self-control following
epilepsy.

Pregnancy may be a secondary cause of the malady: it may lead to
more frequent and severe seizures in women who are already victims;