Epilepsy (epilepsia, 'a seizure') is a chronic functional disease of the nervous system, manifested by recurring attacks of sudden insensibility or impairment of consciousness, commonly accompanied by convulsive seizures of a peculiar kind. The term is not now applied to such symptoms when they are due to organic disease of the brain, heart, or other organs. Thus, we apply the name syncope to sudden unconsciousness from failure of the heart; and we speak of Eclampsia (q.v.) or epileptiform convulsions when the cause is apoplexy, or tumour of the brain, or disease of the kidneys, or teething. It is the underlying morbid condition, not the mere seizures, that constitutes the disease. Epilepsy affects all races of man, and is not unknown among lower animals. Its striking phenomena have been described by the oldest medical writers. By the ancients it was regarded as due to demoniac possession, or to the anger of an offended deity. Their physicians, likewise considering its cause to be supernatural, called it the morbus sacer. Hippocrates alone, to his credit be it said, maintained that its origin was no more supernatural than that of any other disease. The Romans regarded it as an evil omen if any one took a fit during the conduct of public business, and adjourned the meeting for the day. Hence they termed it morbus comitialis. The common English name, derived from one of its most prominent symptoms, is the 'falling sickness.'
The phenomena of the disease are so multiform that it is impossible here to do more than describe the main types of its severe, slight, and irregular forms. (1) In the severe form, or epileptic 'fit' proper (the grand mal of the French), the patient, it may be without warning, utters a strange inarticulate cry, and falls suddenly to the ground insensible, as if struck by lightning. He usually has no time to save himself, but knocks against any object near him, and may thus receive serious injury, or he may fall into the fire, or into water. He becomes deadly pale, his body rigid, with the back arched and the features set, and he ceases to breathe. Soon the colour changes, the face becomes livid purple, the veins of the neck swell up and pulsate, the eyeballs protrude, a gurgling sound is heard in the throat, and death seems imminent. But almost immediately breathing begins again, and the whole body is thrown into a series of successive convulsive twitchings or jerkings. The trunk and limbs are thrown about in various ways, the face is hideously contorted, the tongue jerked out between the teeth and often bitten, the jaws convulsed so that the teeth may be broken. A blood-stained foam escapes from the mouth. After about two or three minutes the jerkings cease, leaving the patient prostrate and comatose for a time. Then he may open his eyes, look around him with a dazed expression, and go to sleep. On awakening he is quite unconscious of what has happened; he may have a severe headache, or be morose and irritable; in rare cases, he feels much freer mentally than before the fit. Sometimes a condition of homicidal mania follows the fit, when the patient attacks any one he may see. The fits are usually separated by intervals varying from some hours to some months; but a very grave condition supervenes (called the status epilepticus) when one fit succeeds another before the stage of coma has passed off. The attacks may be preceded by a distinct 'warning,' or aura, as it is called. These may be very short, or may permit of the patient putting himself in a position of safety before the attack comes on, or even of preventing it. The auræ vary greatly, but in each case the same aura usually precedes the fits. There may be peculiar sensations, such as flashes of light, perceptions of colour, strong odours, or strange tastes or sounds, or visions of various forms, peculiar sensations running up from the fingers or toes towards the head, or sinking at the heart or at the pit of the stomach, or twitchings of groups of muscles.
(2) Slight Forms (Fr. petit mal).—These are often spoken of as 'faints,' 'turns,' 'sensations,' 'giddiness' (see VERTIGO); and, though they are as truly epileptic as the attacks above described, they are usually regarded as altogether trivial. There may be merely a momentary confusion of thought or loss of consciousness. Thus, one while in the act of speaking may suddenly stop, stare fixedly, become pale and unconscious. In a second or two he is quite himself again, and may finish the sentence he had begun, or he may make some random remark, or perform some absurd act automatically, before he comes quite round. In other cases there may be a momentary giddiness, when objects seem to rotate, or the patient himself seems to be wheeled round, and then unconscious supervenes. Or there may be a feeling of faintness, or a momentary twitching of one or two groups of muscles, with pallor of the face and unconsciousness.
(3) Irregular Forms of Epilepsy.—Dr Hughlings Jackson has investigated a form in which there are spasms of the same nature as those in the severe fit, but limited to single groups of muscles, or spreading from one group to another, while consciousness is either not lost at all, or only at a late stage in the attack. In other forms, complicated and purpose-like acts may be carried out in an automatic manner, of which the patient afterwards retains no recollection. Under this category come many attacks of kleptomania, dipsonomia, and many motiveless murders.
The mental condition of epileptics between the attacks varies much. In about one-third of all cases the mind seems to be unimpaired. Napoleon Bonaparte, Peter the Great, Mohammed, and Julius Cæsar are examples of epileptics with highly developed mental faculties. In the majority of cases, however, there is some defect, which may be merely a gradually increasing failure of memory, or insanity, or hopeless imbecility. Very often there is uncertainty of temper, moroseness, or criminal tendencies. The mental deterioration seems to be influenced more by the early commencement and duration of the disease, and by the frequency of the fits, than by their severity or their form. The disease may begin at any period of life, perhaps most commonly between the thirteenth and seventeenth years. The fits may occur during sleeping or waking. They are themselves rarely fatal, except by some accident, such as suffocation, burning, or injury, or when they succeed each other so rapidly that the patient does not become conscious in the interval.
The brain after death presents no appearance that can be called characteristic of the disease. In most cases it appears typically healthy. Such abnormal conditions as are present are in most cases accidental, or the consequences of the repeated fits. In some cases thickening of the skull or of the membranes, or tumours in the brain, are present, and have by their irritation caused the fits. Probably the brain changes are too fine to be detected by our present means of research. Up till recently it was always taught that the medulla oblongata acted as the starting-point of the fits, spasm of its vaso-motor centre causing contraction of the vessels of the brain, and cutting off its supply of blood—a condition which experiment has shown to produce convulsions. Lately the view has been gaining ground that the change begins in the nerve-cells of the gray matter of the surface of the cerebrum, and that it is due to an inordinate discharge of nerve energy.
The causes of the disease are often altogether obscure. The two factors of most importance are, first, the inheritance of nervous instability from ancestors who have suffered from epilepsy or some other form of nervous disease, or who have damaged their nervous systems by alcoholic or other excess; and secondly, alcoholism on the part of the patient himself. Teething in children, fright, mental excitement, injuries to the head, or intestinal worms are not infrequent causes.
Treatment.—During the onset, when the aura is prolonged, the fit may sometimes be arrested by a bandage tied tightly round the limb along which the peculiar sensation passes, or in other cases by stimulation of the nostrils by snuff or ammonia. In such cases the appropriate remedy should be always ready at hand. During the attack there is nothing to be done except to put the patient into the horizontal position, loosen his neckcloth, and let him have plenty of air. The most severe fits usually terminate spontaneously, and any treatment beyond endeavouring to prevent suffocation is unnecessary and often injurious. After the fit is over, the patient should be allowed to sleep. In the general management of the case between the fits, a quiet, regular life, if possible in the country, with a moderate amount of physical and mental exercise, should be enjoined. The calling must be such that there is no risk to life in the event of a fit occurring. Children should be educated, but not overpressed. The dietary should be simple and digestible, with much milk, eggs, and vegetables, but without altogether excluding meat. Alcohol, coffee, and tea should be absolutely forbidden. Marriage seems to have no effect on the disease, but it must be remembered that the children of such unions are apt to suffer from nervous disease. Intermarriage of epileptics should be absolutely discouraged. With regard to the medicinal treatment, although there is no specific against epilepsy comparable to the action of quinine in malaria, the bromide compounds are the most efficacious. But it is essential to success that their use be persevered in steadily for long periods. The mistake commonly made is to use the remedy for a week or two after the attacks, and then to discontinue it till the next fit occurs. The patient should be aware that hope of cure cannot be held out to him unless he persists faithfully with the treatment. In all cases sources of irritation must be carefully sought for; their removal often serves to cure the disease. Cerebral surgery has achieved brilliant results recently in the removal of such sources of irritation to the brain as diseased bones of the skull, and even tumours in the organ itself; but operations on the brain are always such serious matters that they are not to be undertaken without due consideration of the risks run not only to life, but to usefulness of limbs, and after careful comparison of these dangers with the benefit likely to be derived from surgical interference.