Epilepsy, Hysteria, and Neurasthenia: Their Causes, Symptoms, & Treatment. Isaac George Briggs
mal often occurs in people who do not suffer from grand mal, the symptoms consisting of a loss of consciousness for a few seconds, the seizure being so brief that the victim never realizes he has been unconscious. He suddenly stops what he is doing, turns pale, and his eyes become fixed in a glassy stare. He may give a slight jerk, sway, and make some slight sound, smack his lips, try to speak, or moan. He recovers with a start, and is confused, the attack usually being over ere he has had time to fall.
If talking when attacked, he hesitates, stares in an absent-minded manner, and then completes his interrupted sentence, unaware that he has acted strangely. Whatever act he is engaged in is interrupted for a second or two, and then resumed.
A mild type of petit mal consists of a temporary blurring of consciousness, with muscular weakness. The victim drops what he is holding, and is conscious of a strange, extremely unpleasant sensation, a sensation which he is usually quite unable to describe to anyone else. The view in front is clear, he understands what it is—a house here, a tree there, and so on—yet he does not grasp the vista as usual. Other victims have short spells of giddiness, while some are unable to realize "where they are" for a few moments.
Frequent petit mal impairs the intellect more than grand mal, for convulsions calm the patient as a good cry calms hysterical people. After a number of attacks of petit mal, grand mal usually supervenes, and most epileptics suffer from attacks of both types. Some precocious, perverse children are victims of unrecognized petit mal, and when pushed at school run grave risks of developing symptoms of true epilepsy. The "Little Evil" is a serious complaint.
CHAPTER II
RARER TYPES OF EPILEPSY
If it be true that: "One half the world does not know how the other half lives", how true also is it that one half the world does not know, and does not care, what the other half suffers.
Epilepsy shows every gradation, from symptoms which cannot be described in language, to severe grand mal. Gowers says: "The elements of an epileptic attack may be extended, and thereby be made less intense, though not less distressing. If we conceive a minor attack that is extended, and its elements protracted, with no loss of consciousness, it would be so different that its epileptic nature would not be suspected. Swiftness is an essential element of ordinary epilepsy, but this does not prevent the possibility of deliberation."
In Serial Epilepsy, a number of attacks of grand mal follow one another, with but very brief intervals between. Serial epilepsy often ends in
Status Epilepticus, in which a series of grand mal attacks follow one another with no conscious interval. The temperature rises slowly, the pulse becomes rapid and feeble, the breathing rapid, shallow and irregular, and death usually occurs from exhaustion or heart-failure. Though not invariably fatal, the condition is so very grave that a doctor must instantly be summoned. Nearly all victims of severe, confirmed epilepsy (25 per cent of all epileptics) die in status epilepticus.
Jacksonian Epilepsy, named after Hughlings Jackson, who in 1861 traced its symptoms to their cause, is not a true epilepsy, being due to a local irritation of the cortex (the outermost layer) of the brain.
There is usually an aura before the attack, often a tingling or stabbing pain. The chief symptoms are convulsions of certain limbs or areas of the body, which, save in very severe cases, are confined to one side, and are not attended by loss of consciousness.
The irritation spreads to adjacent areas, as wavelets spread from a stone thrown into a pond, with the result that convulsions of other limbs follow in sequence, all confined to one side.
As every part of the brain is connected to every other part by "association fibres", in very violent attacks of Jacksonian epilepsy the irritation spreads to the other side of the brain also, consciousness is lost, the convulsions become general and bilateral, and the patient presents exactly the same picture as if the attack were due to grand mal.
All degrees of violence are seen. The convulsions may consist only of a rapid trembling, or the limb or limbs may be flung about like a flail.
Jackson said: "The convulsion is a brutal development of a man's own movements, a sudden and excessive contention of many of the patient's familiar motions, like winking, speaking, singing, moving, etc." These acts are learned after many attempts, and leave a memory in certain groups of brain cells; irritate those cells, and the memorized acts are performed with convulsive violence.
The convulsions are followed by temporary paralysis of the involved muscles, but power finally returns. As we should expect, this paralysis lasts longest in the muscles first involved, and is slightest in the muscles whose brain-centres were irritated by the nearly exhausted waves. If the disease be untreated, the muscles in time may become totally paralysed, wasted, and useless.
Friends should very carefully note exactly where and how the attack begins, the exact part first involved, and the precise order in which the spasms appear, as this is the only way the doctor can localize the brain injury. The importance of this cannot be overrated.
The consulting surgeon will say if operation is, or is not, advisable, but operation is the sole remedy for Jacksonian epilepsy, for the causes that underly its symptoms cannot be reached by medicines.
Patients must consult a good surgeon; other courses are useless.
Psychic or Mental Epilepsy is a trance-state often occurring after attacks of grand or petit mal, in which the patient performs unusual acts. The epileptic feature is the patient's inability to recall these actions. The complaint is fortunately rare.
The face is usually pale, the eyes staring, and there may be a "dream state". Without warning, the victim performs certain actions.
These may be automatic, and not seriously embarrassing—he may tug his beard, scratch his head, hide things, enter into engagements, find the presence of others annoying and hide himself, or take a long journey. Such a journey is often reported in the papers as a "mysterious disappearance". Yet, had he committed a crime during this time, he would probably have been held "fully responsible" and sentenced.
The actions may be more embarrassing: breaking something, causing pain, exhibiting the sexual organs; the patient may be transported by violent rage, and abuse relatives, friends or even perfect strangers; he may spit carelessly, or undress himself—possibly with a vague idea that he is unwell, and would be better in bed.
Finally the acts may be criminal: sexual or other assault, murder, arson, theft, or suicide.
In this state, the patient is dazed, and though he appreciates to some extent his surroundings, and may be able to answer questions more or less rationally, he is really in a profound reverie. The attack soon ends with exhaustion; the victim falls asleep, and a few moments later wakes, ignorant of having done or said anything peculiar.
We usually think of our mind as the aggregate of the various emotions of which we are actually conscious, when, in reality, consciousness forms but a small portion of our mentality, the subconscious—which is composed of all our past experiences filed away below consciousness—directing every thought and act. Inconceivably delicate and intricate mind-machinery directs us, and our idlest fancy arises, not by chance as most people surmise, but through endless associations of subconscious mental processes, which can often be laid bare by skilful psycho-analysis.
Our subconscious mind does not let the past jar with the present, for life would be made bitter by the eternal vivid recollection of incidents best forgotten. Every set of ideas, as it is done with, is locked up separately in the dungeons of subconsciousness, and these imprisoned ideas form the basis of memory. Nothing is ever forgotten, though we may never again "remember"