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Convulsions During Early Life and Epilepsy

It has long been considered an established fact that prolonged delivery and forceps injuries during this period have acted as active causative factors of a subsequent epilepsy. One can grant that disturbances of various kinds during fetal life may bring about destructive effects in the brain, with consequent mental defect, paralyses of various kinds, epilepsy, etc. During prolonged delivery there must necessarily result a marked change in circulation within the cranial cavity, but the question arises as to whether nature has not provided for this. If it were true that the majority of prolonged deliveries resulted in epileptic and defective children, many, many more first born would present as such. So far as all available statistics go, but very few of the many thousands of first born children become epileptic.

During the protracted delivery with the change in the cerebral circulation there no doubt occurs a transitory cerebral oedema, which may be, so far as known, physiological in nature. If sufficient injury to meningeal or other vessels results during the period of birth serious hemorrhage may occur with consequent damage to the brain itself. The majority of the severe cases of this kind, however, succumb within a few hours or days after birth. Prompt operation on selected cases of subdural hemorrhage has resulted in the disappearance of the symptoms with subsequent normal development.

Even though convulsions did occur in the infant directly after birth, barring those cases of large cerebral or subdural hemorrhage, it does not necessarily follow that if such an infant survives that it later becomes epileptic.

It was found, in an effort recently made to obtain some statistics along these lines, that many of the obstetricians consulted did not have readily available data pertaining to the matter, but considering the statistics obtainable which were based on over 30,000 births, the percentage of infants having convulsions immediately or shortly after delivery was exceedingly small, much less than one per cent. In a series of several thousand births reported by a prominent obstetrician those infants presenting convulsions directly after birth and who survived, not one, up to the age of 25 years, the period of observation, had become

epileptic. On the other hand another prominent medical man asserted the causes that brought about convulsions immediately after birth must later produce epilepsy. Again, another stated that in his opinion there is little or no relationship between convulsions in infancy and a later epilepsy, in a series of 2,100, he saw no cases of convulsions immediately after delivery.

The majority of pediatricians are of the opinion that barring those infants having convulsions immediately or shortly after birth, the symptoms being the result of actual damage to the brain at that time, the majority of patients having convulsions during early life have such as result of a spasmophilic condition, which as a rule in the process of development and growth in the individual later disappears. One observer stated that 50 per cent of infants and children have one or more convulsions, and of these but very few have a subsequent epilepsy. It is a matter of common knowledge that history of one or two convulsions during the infancy of non-epileptic adults is very common. Another observer stated in children suffering from rickets or acute gastro-intestinal disturbance or acute infectious convulsive seizures are actual clinical phenomena which are not liable to crop up as epilepsy in later years. Another asserted "85 to 90 per cent of infantile convulsions are a manifestation of spasmophilia, of the remaining 10 to 15 per cent of convulsions occurring during infancy, organic changes in the brain are the cause. These children may later continue to have convulsions in the way of an epilepsy.'

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Another writer states "there are many cases of epilepsy, perhaps the majority, in which there is no history of convulsions in infancy and early childhood.'

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The general impression had, therefore, by the large number of pediatricians consulted is that infantile convulsions are rarely primarily due to epilepsy. An actual meningitis or encephalitis occurring as a complication of an acute infectious disease may, of course, result in permanent organic change with a subsequent epilepsy.

Chronic Epilepsy

Hippocrates recorded the opinion still held that the seat of epilepsy is in the brain. A hereditary defect either similar or dissimilar may be transmitted so that its influence may play a

very large part in the development of epilepsy in the descendant. The predisposition thus created causes the potential epileptic to be born into the world with an endowment below the normal, a handicap which prevents him from being able to resist deleterious influences which may subsequently act upon him. If an individual with such an original endowment defect is fortunately placed as to his environment during infancy, childhood and adolescence enough resistance may be developed so that the possibility of the bringing out of an epilepsy during the adult period is quite remote.

Many applicants after having had the symptoms of their disorder for a considerable period and having pursued various courses of treatment are finally admitted to the Colony expecting that some marvelous specific remedy will at once be administered so that they may be restored to perfect health within a very short space of time. Naturally these persons are more or less disappointed because no such outcome is possible. Too little consideration is ofttimes given by persons arranging for applicants to enter the Colony to the fact that where the disorder has been present for some years there is associated with it directly or indirectly a permanent structural change of the brain showing itself by perhaps a mental impairment or paralysis. When people once realize that mental impairment, paralysis, convulsions, etc., often follow or go hand in hand with a destruction of essential parts of the brain, there will not then be expected these unattainable results. When there is but a disturbance of function of essential brain cells and no permanent damage to these most important tissues proper treatment may bring about a readjustment of the entire vital mechanism as it were and so cause a cessation of the symptoms of epilepsy.

There seems much evidence to establish the fact that many an epileptic is such as the result of a lack of normal progressive development during the antenatal period of existence. Gross organic defect, e. g., a porencephaly, results from destruction of brain tissue during foetal life, the causative factor being what it may, in some a hereditary syphilis.

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