Diseases of the nervous system / edited by Archibald Church.

Date:
1908
Catalogue details

Licence: In copyright

Credit: Diseases of the nervous system / edited by Archibald Church. Source: Wellcome Collection.

    1121/1256 (page 1079)
    from the region of the heart or from the extremities. “Everything becomes numb,” “ there is a spasm all over,” “ a ball rises to the head.” In connection with the aura the patient slips to the floor; sometimes there is an impression that he throws himself upon the ground. Rarely is there such an abrupt fall as in the epileptic attack. Injuries due to the fall are, therefore, extremely rare. Where these are noted in the hysterical attack they are almost always due to the powerful spasmodic contractions of the later stages. The epileptoid phase consists of tonic and clonic spasms which resemble those of the epileptic attack. The tonic spasms often precede the clonic, as is the rule in the epileptic attack. The head is spasmodically thrown to and fro; the eyes are commonly spasmodically closed; the angle of the mouth is distorted by the spasm; arms and legs are in tonic extensor or flexor spasm; the jaws are pressed together, rarely is the mouth wide open; the muscles of the trunk often present tonic rigidity. In consequence of a transitory arrest of respiration (usually in the inspiratory position) there is occasionally slight cyanosis. After from 30 seconds to a minute this tonic spasm is re- placed by clonic convulsions. These are at first apparently distributed over the entire body and, therefore, also at the first glance resemble epilepsy. Upon careful examination, however, significant differences are noted in regard to the tonic as well as the clonic convulsions. Above all, the muscle con- tractions are not so uniformly distributed over the entire body. There is a certain “ choice ” and “ coordination ” even in the epileptoid phase which is even more distinct in the succeeding stage. The tonic trunk and head con- tractions are more complicated than is generally noted in epilepsy. The tonic spasm of the extremities brings about postures which indicate that psychical, selective factors are operative. The “ uniform ” generality of the epileptic attack, in which, according to physiologic laws, the flexors pre- dominate over, the extensors, is lacking. This choice is even more distinct in the clonic spasm. Many authors, therefore, include this with the succeed- ing stage. It is especially noteworthy that the hands and arms rather present a coordinated tremor than an incoördinated clonic spasm. The legs often show kicking and stamping movements which resemble voluntary movements or those due to emotion. THE PHASE OF COORDINATED SPASMODIC MOVEMENTS arises quite gradually from the epileptoid stage. I designate it briefly as the stage of jactitation. The patient now assumes complicated positions and performs complicated movements which distinctly betray coordination, that is, selection. Very frequently these resemble greatly exaggerated forms of expression and are, therefore, similar to those of the next stage. Some of these positions and movements have a special name, on account of their frequency or their conspicuousness. We speak of an arc de cercle, when the patient arches the trunk in opisthotonus to such an extent that finally only the tips of the toes and the occiput or—when the head is even more strongly retracted—even the forehead are in contact with the floor or the bed. Quite as common are the contortions of the trunk, sometimes winding movements, at other times a rigid lateral curvature. The head is thrown about, the hair flies around the head, sometimes following the rotations of the trunk. 70