Characteristic paroxysm of the Major attacks
Categories: Diseases of The Nervous System
This may be ushered in by a
localized sensation, known as the Aura, in some part of the body; but it
may come without any warning and suddenly. The convulsions begin suddenly
and at first are tonic, that is, it does not change but holds on. Thc
patient falls unconscious regardless of the surroundings, and the
unconsciousness may be preceded by an involuntary piercing cry. The head
is drawn back and often turned to the right.
he jaws are fixed (tonic
spasm). The fingers are clenched over the thumb and the extremities are
stiff. The breathing is affected and the face looks blue. The urine and
bowel contents may escape; but this occurs oftener in the next stage. This
tonic spasm usually lasts from a few seconds to a half minute when it is
succeeded by the clonic spasm stage.
Clonic spasm stage. In this the contraction of the muscles is
intermittent. (Tonic spasm is the opposite condition.) At first there is
trembling, but it gradually becomes more rapid and the limbs are jerked
and patient tosses violently about. The muscles of the face are in
intermittent motion, the eyes roll, the eyelids are opened and closed
convulsively. The jaws move forcibly and strongly, and the tongue is apt
to be caught between the teeth and bitten. The blue look now gradually
decreases. A frothy saliva, which may be bloodstained from the bitten
tongue, escapes from the mouth. The urine and bowel contents may escape
involuntarily. The length of time of this stage is variable. It may last
two minutes. The contraction becomes less violent and the patient
gradually sinks into the condition of deep sleep, when the breathing is
noisy and stertorous, the face looks red and swollen, but no longer
bluish. The limbs loose their stiffness and unconsciousness is profound.
The patient, if left alone, will sleep for some hours and then awakes and
complains only of a dull headache. His mind is apt to be confused. He
remembers nothing or little of what has occurred. Afterwards the patient
may be irrational for some time and even dangerous.
The minor attack or "petit mal."--There is a convulsion; a short period of
unconsciousness, and this may come at any time, and may be accompanied by
a feeling of faintness or vertigo. Suddenly, for example, at dinner time
the person stops talking and eating, the eyes are fixed and staring and
the face is slightly pale. The patient usually drops anything he may be
holding. The consciousness returns in a moment or two and the patient
resumes conversation as if nothing had happened. In other instances there
is a slight incoherency or the patient performs some almost automatic
action. He may begin to undress himself, and on returning to consciousness
find that he has partially disrobed. He may rub his beard or face, or may
spit about in a careless way. An eminent physician states: "One of my
patients, after an attack, was in the habit of tearing anything he could
lay his hands on, particularly books; violent actions have been committed
and assaults made, frequently giving rise to questions which come before
court. In the majority of cases of "petit mal" (light attacks) convulsions
finally occur, at first slight, but ultimately the grand mal (major
attacks) becomes well developed, and the attacks may then alternate."
Recovery. The authority above goes on to say: "This may be given today in
the words of Hippocrates: 'The prognosis in epilepsy is unfavorable when
the disease is congenital (that is, existing at birth), when it endures to
manhood, and when it occurs in a grown person without any previous cause.
The cure may be attempted in young persons but not in old.' '' Death
rarely occurs during the fit, but it may happen if the patient is eating.
If the attacks are frequent and the patient has marked mental disturbance
the conditions are unfavorable. Males have a better outlook than females.