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.