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.