EPILEPSY (Symptoms and Types)

Epilepsy comprises a group of disorders characterized by transient, recurrent episodes of clouding or loss of consciousness, sometimes with convulsive movements or automatic behavior. These symptoms, often referred to as “seizures,” are associated with disturbances in the electrical discharges of the brain —that is, cerebral dysrhythmia.Epilepsy is said to have the longest medical history of any disease. The word itself is derived from the Greek word for “seize,” and in ancient times it was called the sacred disease, since it was believed to be due to divine visitation. Hippocrates, however, wrote prophetically, “Surely it too has its nature and causes whence it originates, just like other diseases, and is curable by means comparable to their cure.”Many historical figures have been subject to seizures—among them Caesar, Mohammed, Napoleon, Lord Byron, de Maupassant and Van Gogh. The present incidence of epilepsy in the United States has been estimated at between one and a half and two million. All races, and both sexes, are about equally subject to the disorder. Although it may have its onset at any age, over half of known cases appear before age fifteen. Thanks to the newer drugs, relatively few cases require institutional care today, and psychoses associated with convulsive disorders constitute only about 1.4 per cent of first admissions to mental hospitals.Epileptic seizures take innumerable forms, depending on the precipitating cause, region of the brain affected, and character of the electrical discharge. They can be grouped, however, into four main types, each of which has its characteristic electroencephalograph or brain wave record (PLATES 10, 11, 12, and 13).1. The most common and dramatic form of epilepsy, occurring in 60 per cent of cases, is grand mal, or “great illness.” The typical brain wave pattern for this form of the disorder is a series of rapid sharp spikes. About half of these seizures start with a momentary warning “aura,” usually too brief to permit the individual to prepare himself. The aura varies with the brain area involved, and may consist of stomach distress, numbness, unpleasant smells, noises, flashes of light or twitching muscles. ‘This opening phase is immediately followed by the “tonic” phase in which consciousness is suddenly and completely lost, the arms and legs rigidly contract, and the patient falls and may injure himself. In this phase breathing is suspended, the face turns pale, the pupils dilate, the bladder usually empties, and contracting chest and laryngeal muscles may produce a peculiar “epileptic cry.” After ten to twenty seconds the “clonic” phase sets in, and for about a minute there are acute muscle spasms. The head strikes the ground, the legs jerk up and down, and the jaws open and shut so forcefully that a foamy mixture of air and saliva is generated. At this point there is danger of biting the tongue, and an object such as a pen should be thrust between the teeth on one side of the mouth. Within a few moments the convulsive movements begin to subside, and the patient either returns to consciousness or falls into a deep post-convulsive “coma” characterized by stertorous breathing, facial congestion, and absence of tendon reflexes. This is followed by a deep sleep of an hour or two. On awakening, the patient is usually bewildered and complains of headache and fatigue.Some patients have grand mal attacks during sleep or just as they are falling asleep. A few suffer from status epi- lepticus in which one seizure follows another without intervening recovery of consciousness. This is a dangerous condition, but it can be arrested by medical means.2. In petit mal or small illness epilepsy, consciousness is suddenly disturbed or interrupted without warning. In the most common form the patient does not fall, but stops whatever he is doing and sits for a few seconds with staring eyes and expressionless face. There is often a rhythmic twitching of the eyes, and he will probably drop anything he is holding. Immediately afterward he resumes his activities and may not even be aware of his momentary “absence.”Petit mal occasionally takes other forms. One type is the “akineticseizure in which there is a sudden muscular collapse accompanied by head nodding or falling. Another is the “myoclonic” seizure, during which the arm muscles contract but consciousness is usually retained Petit mal seizures tend to be frequent, varying from one or two to several dozen attacks a day. The illness usually starts between the ages of four and eight, but it may have its onset during adolescence. These smaller attacks sometimes develop into grand mal seizures, and occasionally the two types exist together. The typical electroencephalograph record shows wave-and- spike patterns.Illustrative Case:Eddie F., is a twenty-seven-year-old single man who has a history of grand mal, petit mal, and psychomotor seizures. The petit mal condition was noticed first when the patient was ten years old. Since that time he has shown various other forms of convulsive disorder, and has been on continuous medication.He was referred to a psychiatric hospital when he was twenty-two years old because of uncontrollable seizures involving both legs. The condition cleared spontaneously soon after hospitalization. After six months in the hospital, the patient was discharged. Two months later, he was admitted to the city hospital in a dirty, unshaven, confused state. He appeared to be having auditory hallucinations, and had the delusion that someone was trying to kill him. He was referred to the psychiatric hospital where a diagnosis was made of chronic brain syndrome associated with a convulsive disorder. Within several days the patient’s condition improved, although there was a loss of memory for the entire episode.The patient was sickly as a child, and frequently ran high fevers without apparent cause. He was a feeding problem throughout his early years. When he entered school, he had trouble concentrating and did poor academic work. His teachers described him as a “dreamy” individual. However, intelligence tests showed that he was of well above average intelligence. The first convulsive seizures were noted when he was twelve years old. He was working as a caddy at a golf course and his companion noticed that he had brief blackout periods. The mother recalled instances in which she had seen him blink his eyes and seem dazed for a few seconds at a time when he was younger. Eventually neurological examinations were undertaken, and a diagnosis of convulsive disorder was established. As he grew older, Eddie showed various behavior problems and adjustment difficulties. On one occasion he ran away from home, on another he stole an automobile, and he had an extremely poor work record. There is also a history of heterosexual promiscuity and homosexual prostitution.When seen at the hospital, the patient was a neat, pleasant, and co-operative young man who appeared eager to talk about his problems. While there was some irrelevancy, there were no signs of disorientation, delusions, hallucinations, or other psychopathology. His judgment appeared good, and there was some degree of insight. (Kisker, 1964)

Cite this page: N., Pam M.S., "EPILEPSY (Symptoms and Types)," in PsychologyDictionary.org, November 28, 2018, https://psychologydictionary.org/epilepsy-symptoms-and-types/ (accessed May 24, 2019).
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