The temperature is usually lowered before the attack, but the surface temperature is increased during or after the second stage.
Cutaneous sensibility is often very much disturbed. Spots of hyperæsthesia and anæsthesia are sometimes left after the attack. The scalp is not infrequently exceedingly tender. The sensory troubles have been alluded to as prodromata of the ordinary motor attack. Some attacks of the sensory variety in which psychical excitement plays a part are characterized by unilateral and persistent formications.
A consequence of some epileptic paroxysms is the appearance of petechiæ, chiefly upon the face, neck, and upper extremities. The skin of old epileptics is harsh, cold, and rough, and the face is apt to be studded with spots of acne even when the patient is not taking the bromides. The hair is stiff and dry, and the ears and tip of the nose are apt to be the seats of a passive and old hyperæmia.
The urine of epileptics is apt to contain evidence of muscular waste, and an increase in the amount of earthy phosphates as well. Zapolsky found, however, that immediately after the attack there was diminution in the quantity of the phosphates. The occurrence of glycosuria has been noted by numerous clinicians. De Renzi29 has published an interesting article. I have seen no less than six well-marked cases within two years in which constant glycosuria was a feature of the disease, but in two of the patients well-marked symptoms of disease of the pons were present. After the paroxysm it is by no means uncommon to find the urine loaded with albumen. Otto, Mabille, Saundby, Bazin, and other writers speak of a transitory albuminuria. Kleudgen,30 however, does not attach much importance to this feature, believing that the albumen is often due to semen.
29 Gior. internaz. d. Sc. Med., Napoli, 1880, ii. 357-359.
30 Archiv für Psychiatrie, etc., 1880, xi. 478-506.
The tendinous reflexes are frequently abolished during the attack, but not always so, and in several cases in which I was enabled to make a test during the convulsion I found that the patellar reflex was very active, and in one case elsewhere reported it was transferred. The skin reflexes are ordinarily exaggerated.
Tongue-biting is, I think, a more common feature of the nocturnal than the other attacks. It is rare in infantile epilepsy, and is always a bad feature. The wound is sometimes very serious, and cases are mentioned where the tongue has been severed. An occasional sequel of the attack is a urinary difficulty and vesical tenderness. It is sometimes connected with great urethral irritability and spasmodic stricture, which prevents the introduction of a sound or catheter. Romberg speaks of the supervention of asthma and dysphagia.
THE IMMEDIATE AND REMOTE EFFECTS OF THE EPILEPTIC PAROXYSM.—As a result of violence we often find wounds and bruises, quite rarely fractures, but more often dislocations. Cases have been communicated to me where as a result simply of the great muscular force the humerus has been dislocated at its superior articulation. Muscular pain of great severity, and sometimes of great persistency, follows unusually severe fits, and rupture of muscular substance is not uncommon. An epiolecranon bruise in one of my cases produced a severe neuritis which was very intractable. In old cases, according to Axenfeld, there may be great muscular hypertrophy, the sterno-mastoidii attaining the size of the biceps, and in other cases there is fatty degeneration. He also calls attention to defects that may be due to frequent exercise of violence upon bones through repeated exaggerated muscular contraction. Paralysis of nerves which supply convulsed members is mentioned.
The psychical effects are various. For several days following the attack there may be simply confusion of ideas, irresolution, or drowsiness, which subsides in a short time. In not a few cases I have regarded the attack as beneficial in the sense of an explosion of relief when perverted mental states had preceded it. In such persons the discharging lesion was followed by a very conspicuous restoration of the mental equilibrium.