Occasionally the attacks are terminated by great violence or screaming or the commission of purposeless acts.
Post-epileptic aphasia has been described by Winslow, Moreau, and others, and among my own cases of the sensory variety of this disorder I have met with speech disturbance. The aphasia is of short duration, and consists either in a total incapacity for verbal expression or a transposition. It is not rare for it to be associated with the commission of a number of quasi-automatic actions.
Unilateral epilepsies are quite apt to leave behind them a species of paresis which may last even for several days. The loss of power is confined to the convulsed members, and may be accompanied by tingling. In the greater number of instances, however, there is some central organic change, and the epilepsy is purely symptomatic.
Deafness, amaurosis, and other pareses of the organs of special sense are rare sequelæ of the epileptic state.
The remote effects of the grave disease are not so decided as when the patient has been the subject of petit mal. Slight repeated losses of consciousness are apt to be followed by mental decay. The ultimate result is mental enfeeblement, a progressive and very great loss of memory, which advances to such an extent that a veritable dementia ensues. With this there is usually a very decided perversion of the emotions and affections, so that a good-natured, amiable child may in a few years become everything that is bad and trying, and the acts of mischief are almost inconceivable. Theft, incendiarism, and various moral perversions are common in some chronic epileptics. The dementia, it is true, is tardy in its establishment, but it comes eventually if the individual lives long enough.
In some individuals there is a very early tendency to the development of mania; there is a certain periodicity about the explosions, and when established the excitement either precedes the attack by a few days or occurs shortly afterward. The violence is characteristically acute, and such insanity very often makes itself known in homicidal acts rather than in those of a suicidal character. Hypochondriasis is quite likely to follow continued epilepsy.
It is the rule for epilepsy to undergo decided modifications in the beginning of its course. The first attack may be simply eclamptic, without any peculiarities or definite character, and with recurrence there is a tendency to regularity and constancy in expression. Infantile convulsions, that may occur at any time after inconsiderable exciting causes, may eventually be confined to the early morning or night. So-called fainting attacks may precede petit mal, and headache may be the precursor of ill-defined seizures. So, too, the relation of grave and light attacks may vary. In the beginning there may be nothing but attacks of petit mal, while later these may be supplemented by severe fits, and even disappear entirely. So far as my own cases go, I find that nearly two-thirds of the entire number happen at night or in the early morning, while the others may occur in the day or at any other time, or by day and night. Besides the terms nocturnal and diurnal, we may use the word matutinal in relation to the time of attack. So far as the number of attacks is concerned, we find great irregularity. It is not always possible to count them, or even to recognize them, for the examples are numerous where nocturnal attacks have been undetected for years, and have finally been followed by fits during the daytime. I have cases who have seizures but once or twice a year, and others who have ten to forty or fifty daily. In some cases there may be eight or ten attacks of petit mal daily, and but two or three grave attacks during the week.
The statistics of Delasiauve and Leuret go to show that of 296 cases of epilepsy, the cases of general epilepsy were most common—that is to say, the attacks which occur both by day and night.
Delasiauve, Herpin, and others make delicate distinctions between the attacks, and the former grades the seizures beginning at accesses, and successively advancing to vertiges, accès intermédiares, and attaques or accès compléts.31 In fact, these are but varying degrees of violence of the discharge, after all. We thus have light discharges and severe discharges at different times, or, as the habit is established, only the light or only the severe, the manifestation depending probably upon the number of discharging cells and the importance of the exciting cause.