One hundred years ago

In the Journal of Nervous and Mental Disease for March Professor Allen M. Starr of New York draws attention to the importance of having a correct view regarding epilepsy. In medical text-books from the earliest times epilepsy has been classed as a functional disease and this view does not seem to have been questioned seriously. Yet a careful review of facts ascertained recently, says Professor Starr, seems to demonstrate the fallacy of the prevailing opinion and to prove conclusively “epilepsy is usually, if not always, an organic disease”. This conclusion is based upon a careful study of 2000 cases of epilepsy which have been seen personally and of which satisfactory records were kept. In the first place it was found possible to draw a fairly sharp line clinically between Jacksonian epilepsy and so-called idiopathic epilepsy. In Jacksonian epilepsy the attack is always recognised by the patient as one of a similar series and consciousness is not lost, at least in the earliest stages of the attack. Four types of Jacksonian epilepsy are recognised – viz., the so-called “motor” type in which the attack starts with a local spasm; the sensory type which is marked by a hallucination (generally crude) of one of the senses at the onset, followed by a temporary suspension of the power of perception in that sense; an aphasic type in which a sudden interference with the function of speech takes place, either in the power of understanding or in the power of uttering speech; and a psychical type in which dreamy states of the mind or imperative ideas dominate consciousness, arresting the normal flow of thought and often leading to automatic acts the object of which is not clear and of which no conscious memory remains. In all these types, says Professor Starr, we consider the Jacksonian attack a sure indication of local irritation of the brain cortex and a symptom of local organic disease. In many cases of idiopathic epilepsy (38 per cent. of Professor Starr's cases) the attack was preceded by a conscious sensation or aura. This aura was in many cases identical in character with the aura initiating a Jacksonian attack. The only difference between a Jacksonian attack of the “motor” type and an idiopathic attack was the extent of the spasm, which in the former began locally and involved only a portion (seldom the whole) of the body, whereas the latter involved the body in a general convulsion.