Definition.—An affection of the nervous system characterized by attacks of unconsciousness, with or without convulsions.

The transient loss of consciousness without convulsive seizures is known as petit mal; the loss of consciousness with general convulsive seizures is known as grand mal. Localized convulsions, occurring usually without loss of consciousness, are known as epileptiform, or more frequently as Jacksonian or cortical epilepsy.

Etiology [...]
Heredity.—Much stress has been laid upon this by many authors as an important predisposing cause, and the statistics collected give from nine to over forty per cent. . . . I was not a little surprised to find in the list of my cases that hereditary influences played so small a part. I have heard this opinion expressed by certain French physicians, notably Marie, who in writing also upon the question takes strong grounds against heredity as an important factor in epilepsy.

[...] Post-epileptic symptoms are of great importance. The patient may be in a trance-like condition, in which he performs actions of which subsequently he has no recollection. More serious are the attacks of mania, in which the patient is often dangerous and sometimes homicidal. It is held by good authorities that an outbreak of mania may be substituted for the fit. And, lastly, the mental condition of an epileptic patient is often seriously impaired, and profound defects are common.

Paralysis, which rarely follows the epileptic fir, is usually hemiplegic and transient.

Slight disturbances of speech also may occur; in some instances forms of sensory aphasia.

The attacks may occur at night, and a person may be epileptic for years without knowing it. As Trousseau truly remarks, when a person tells us that in the night he has incontinence of urine and awakes in the morning with headache and mental confusion, and complains of difficulty in speech owing to the fact that he has bitten his tongue; if, also, there are on the skin of the face and neck purpuric spots, the probability is very strong indeed that he is subject to nocturnal epilepsy.

Source: William Osler, "The Principles and Practice of Medicine" (New York: Appelton, 1892), 948-952

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