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Epilepsy
Pages 115-144

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From page 115... ... Such lightheaded spells or blackouts usually occur only in the first few days after cerebral concussion, but may be present for weeks or months, especially with more severe head injuries. Are they simply to be considered vasomotor phenomena or may they be epileptic? Read the entire page →
From page 116... ... In 31 patients focal convulsions occurred, never progressing to grand mal, and in 26 cases minor attacks such as described previously were never followed by generalized seizures. It is interesting to note that only 12 patients were considered to have psychomotor seizures, although this type of attack is now thought to be the most common in adult life. Read the entire page →
From page 117... ... Although motor warnings were more common with parietal and frontal lobe lesions, they also occurred with wounds of other regions. Somatosensory aurae occurred in 40 cases, and were associated with motor phenomena in 17 cases. Read the entire page →
From page 118... ... Olfactory aurae occurred in five cases, in three of which the smells were said to be unpleasant, in two cases that of burning material, and in one case that of gasoline. Various other aurae were experienced by some 16 patients; a feeling of weakness, a sudden headache, dazed feeling, saliva accumulating in the mouth, a funny feeling, a tightening up, wobbly feeling, lightheadedness, unsteadiness. Read the entire page →
From page 119... ... Table 137. -- Postictal Phenomena in Men With Epilepsy Postictal phenomena Number Percent Postictal phenomena Number Percent Total number 87 42 0 of men with Todd's paralysis 19 9 2 207 100.0 67 32 4 1 9 50 None 66 31.9 Other and unknown 22 10 6 Table 138. -- Incidence of Posttraumatic Epilepsy in Relation to Type of Wound Number of men With 1 or more attacks With multiple attacks Type of wound Any type Focal Number Percent Number Percent Number Percent Number Percent Total 739 100.0 207 28.0 169 22.9 9.7 10.0 65 8.8 No fracture 207 60 100.0 100.0 30 14.5 13.3 20 6 1 .5 Fracture without dural 8 3 5.0 Total without dural penetration 267 100.0 38 14.2 26 9.7 4 1.5 Dural: 448 24 100.0 100.0 157 12 35.0 50.0 132 11 29.5 45.8 58 3 12.9 12.5 Total with dural penetration 472 100.0 169 35.8 143 30.3 61 12.9 630802 -- 62 0 119 Read the entire page →
From page 120... ... "> * " 1 Epilepsy percentage Scalp and Dural cranium penetration 8 CM CO :^ : : :« : : : :? Read the entire page →
From page 122... ... does not give a precise time but refers to von Bergmann's concept that early epilepsies are due to local cortical wounding, so that one may infer he is thinking in terms of hours, or at the most days -- not weeks or months. Specifically, he states that they occur most frequently 2 to 3 days or 8 days after trauma, seldom later. Read the entire page →
From page 123... ... 16 10.0 19.2 15 to <18 months 9 5.9 20.4 18 to <^21 months 4 2.7 21.0 21 to <24 months 3 2.0 21.4 2 to <3 years 17 2.9 23.7 3 to <4 years 10 1.8 25.0 4 to <^5 years 5 .9 25.7 5 to <[ 6 years 6 1.2 26.6 6 to <[7 years 5 1.2 27.5 7 to <[ 8 years 4 1.7 28.8 2 i The rates are based on the 205 men for whom the time of first attack could be determined. Table 142. -- Proportion of Men Having Onset of Posttraumatic Epilepsy in Specified Time Intervals From Injury Authors Time interval from injury 0-1 month 1.1-6 6.1-12 Second year Third year Fourth year Fifth year months months Ascroft (8) Read the entire page →
From page 124... ... If one assumes an incidence of 35 percent for posttraumatic epilepsy in open head wounds (table 139) , 9 to 12 percent of the exposed population will develop fits 2 years or more after a blow to the head. Read the entire page →
From page 125... ... . Table 144. -- Epilepsy in Relation to Age at Injury, Birth History, and Birth Order Number of men With epilepsy With multiple focal attacks Characteristic Number Percent Number Percent Total 739 207 28.0 65 8.8 Age at injury: 1 8 -- 20 years 133 193 162 109 73 69 34 58 54 25 24 12 25.6 30.1 33.3 22.9 32.9 17.4 11 12 16 8.3 6.2 9.9 4.6 8.2 7.2 21 -- 23 years 24-26 years 27 -- 29 years 5 6 30-32 years >33 years 5 Birth history: 701 38 199 8 28.4 21.1 63 2 9.0 5.3 Birth order: First born 186 53 54 41 56 28.5 29.7 28.3 25.9 30.0 14 14 19 16 2 7.5 7.7 13.1 7.4 20.0 Third born 182 145 216 10 Fourth or over 3 Since the first labor is usually more difficult and longer than subsequent ones, the baby of a primipara might be subject to more cerebral anoxia and molding of the head than those of multiparas. Read the entire page →
From page 126... ... Table 145. -- Relation of Epilepsy to Previous Illnesses and Head Injuries Number of men With epilepsy With multiple focal attacks History Number Percent Number Percent Total 739 207 28.0 65 8.8 Previous illnesses: Uncomplicated childhood diseases 635 18 44 188 3 8 9 3 29.6 16.7 18.2 32.1 75.0 59 1 2 3 9.3 5.6 4.5 Complicated childhood diseases. Read the entire page →
From page 127... ... Table 146. -- Relation of Epilepsy to Nervous Disorders in Family With epilepsy With multiple focal attacks Disorder Number of men Number Percent Number Percent Total 739 207 28.0 65 8.8 None 597 20 22 37 30 5 25 11 173 5 5 8 9 2 2 5 29.0 25.0 22.7 21.6 30.0 40.0 54 2 3 1 2 9.0 10.0 13.6 2.7 Fainting , , - Migraine Neurosis Psychosis 1 3 6.7 Unknown 45.5 27.3 F FACTORS AT THE TIME OF WOUNDING WHICH MAY MODIFY THE PROBABILITY OF EPILEPSY It has been known for the past century that certain characteristics at wounding influence the likelihood of the development of epilepsy. Read the entire page →
From page 128... ... . 207 139 20 338 25 10 31 24 3 136 13 15.0 17.3 15.0 2 6 1.0 4.3 Cranium Dura mater 40.2 52.0 50 14.8 28.0 Ventricle 7 Table 148.- -- Relation of Epilepsy to Period of Unconsciousness Number of men With epilepsy With multiple focal attacks Period Number Percent Number Percent Total 739 207 28.0 65 8.8 <2 hours 146 166 57 42 35 15 142 136 29 34 18 14 16 8 58 30 19.9 20.5 31.6 33.3 45.7 53.3 40.8 22.1 8 8 6 6 8 3 16 10 5.5 4.8 10.5 14.3 22.9 20.0 11.3 7.4 2^-24 hours 1-3 days 3-7 days >7 days. Read the entire page →
From page 129... ... conclusion that the presence or absence of foreign bodies had no bearing on the incidence of convulsive sequelae. Table 149. -- Relation of Epilepsy to Neurological Deficit at Time of Wound Number of men With epilepsy With multiple focal attacks Deficit Number Percent Number Percent Total 739 207 28.0 65 8.8 None 341 76 22.3 11 3.2 Hemiplegia or hemiparcsis, sensory or motor 148 55 99 125 74 20 50.0 38 8 19 15 25.7 14.5 19.2 12.0 HemJanopsia 36.4 47.5 33.6 Aphasia 47 42 Other Table 150. -- Relation of Epilepsy to Intracranial Foreign Bodies and Their Removal at Debridement Number of men With epilepsy With multiple focal attacks Intracranial foreign bodies Number Percent Number Percent Total 739 207 28.0 65 8.8 297 144 52 52 36 22 17.5 25.0 42.3 8 2.7 7.6 13.5 Bone fragments only, removed 11 Bone fragments only, not all removed . Read the entire page →
From page 130... ... suggest more than a slight predominance of central lesions. Table 151. -- Relation of Epilepsy to Location of Wound Number of men With epilepsy With multiple focal attacks Region Number Percent Number Percent Frontal 246 372 163 176 83 134 53 42 33.7 36.0 32.5 23.9 24 53 18 13 9.8 14.2 11.0 Parietal Temporal Occipital 7.4 Table 152. -- Epilepsy in Relation to Type of Wound Number of men With epilepsy With multiple focal attacks Type of wound Number Percent Number Percent Total 739 207 28.0 65 8.8 Closed head injuries 50 472 56 158 1 2 9 169 6 23 18.0 35.8 10.7 14.6 .0 .0 2 61 2 4.0 12.9 3.6 .0 .0 .0 Perforating and penetrating wounds . Read the entire page →
From page 131... ... . Although secondary healing increases the incidence of seizures, this seems to follow directly from the greater probability of secondary healing occurring in severely wounded men, for within the individual R-I groups there is no significant difference in the incidence of epilepsy in patients whose wounds heal primarily or secondarily (table 155) Read the entire page →
From page 132... ... . 41 38 25 25 11 61.0 65.8 64.7 17 11 5 41.5 28.9 29.4 Secondary Unknown 17 Table 156. -- Relation of Epilepsy to Complications of Debridement Number of men With epilepsy With multiple focal attacks Complication Number Percent Number Percent Total number with debridement 634 190 30.0 64 10.1 None 520 11 25 15 9 13 3 3 11 27 13 139 5 11 11 4 6 1 26.7 45.5 44.0 73.3 44.4 46.2 33.0 44 2 5 5 1 2 8.5 18.2 20.0 33.3 11.1 15.4 Frank infection Meningitis Fungus cerebri Cerebrospinal rhinorrhea Cerebrospinal otorrhea Cerebrospinal fistula 5 10 45.5 37.0 53.8 Other 7 4 3 14.8 23.1 139 Read the entire page →
From page 133... ... , but since cranioplasty was deferred in more seriously injured patients, it is unclear just what was the role of the time of cranioplasty per se. The majority of plates used for cranioplasty were of tantalum, and so few other materials (acrylic and bone) Read the entire page →
From page 134... ... Other 3 7 3 4 1 57.1 33.3 Table 159.- -- Relation of Epilepsy to Cranioplasty Performed at Debridement * Number of men With epilepsy With multiple focal attacks Time Number Percent Number Percent R-I group 3 Cranioplasty done at debridement . Read the entire page →
From page 135... ... Table 160. -- Relation of Epilepsy to Time of Cranioplasty Number of men With epilepsy With multiple focal attacks Time Number Percent Number Percent R-I group 3 Total 362 115 31.8 30 8.3 No cranioplasty . 145 38 26.2 8 5.5 Cranioplasty: Within 3 months of injury 60 112 45 19 45 13 31.7 40.2 28.9 5 10 7 8.3 8.9 15.6 3 -- 6 months after injury ^>6 months after injury R-I group 4 Total 96 61 63.5 33 34.4 No Cranioplasty 17 11 64.7 6 35.3 Cranioplasty: Within 3 months of injury 10 35 3 23 30.0 65.7 70.6 2 12 13 20.0 34.3 38.2 3 -- 6 months after injury ^>6 months after injury 34 24 Table 161. -- Relation of Epilepsy to Type of Plate Number of men With epilepsy With multiple focal attacks Type of plate Number Percent Number Percent Total with cranioplasty Tantalum 307 128 41.7 49 16.0 Plastic 283 15 9 122 6 43.1 40.0 46 3 16.3 20.0 Other Table 162. -- Relation of Epilepsy to Secondary Operations on Plate With epilepsy With multiple focal attacks Operation Number of men Number Percent Number Percent Total with cranioplasty 307 128 41.7 49 16.0 No secondary operations 280 27 21 115 13 11 41.1 48. Read the entire page →
From page 136... ... , and the proportion of heavy drinkers is depressed, although the differences are not statistically significant. A significantly larger proportion of severely injured men were abstainers than were those with slight or moderately severe wounds, and this is true both of men with and without Table 163. -- Relation of Drinking Habits of Patients to Severity of Wounding and Epilepsy Drinking habits R-I groups Total With epilepsy Without epilepsy Number Percent Number Percent Number Percent AU R-I groups Total 739 100.0 207 100.0 532 100.0 Frequent or bouts 151 506 78 20.4 68.5 10.6 .5 57 127 22 27.5 61.4 10.6 .5 94 379 56 3 17.7 71.2 10.5 .6 Unknown 4 1 R-I groups 1 and 2 (slight wounds) Read the entire page →
From page 137... ... If R-I groups 3 and 4 are combined (since the frequency of constipation is not Table 164. -- Relation of Epilepsy to Constipation Number of men With epilepsy With multiple focal attacks Constipation Number Percent Number Percent All men Total 739 207 28.0 65 8.8 None 561 124 49 5 147 37 20 3 26.2 29.8 40.8 60.0 43 8 13 1 7.7 6.5 26.5 20.0 Orcasional difficulty Unknown R -- I groups 3 and 4 Total 458 176 38.4 63 13.8 None .... 348 74 31 5 127 31 15 3 36.5 41.9 48.4 60.0 42 7 13 1 12.1 9.5 41.9 20.0 Occasional difficulty Chronic Table 165. -- The Course of Posttraumatic Epilepsy in 7- to 8-Year Period Frequency of attack Any Type of attack Major Minor Number Percent Number Percent Number Percent Total .... Read the entire page →
From page 138... ... This favorable course has been known for patients having their initial epileptic manifestations within a few days of a head injury. These convulsions have generally been considered to result from the reaction to the acute stage of hypercmia, edema, necrosis, and glial reaction of the brain, whereas the later epilepsies are thought to be related to the chronic scarring of the brain; Rottgen (103) Read the entire page →
From page 139... ... Group 2: 126 men having one or more attacks in the first 4 years and continuing to have attacks. 60 MEN WITH MINOR ATTACKS ONLY MEN WITH MAJOR ATTACKS.WITH OR WITHOUT MINOR ATTACKS 3 6 9 12 15 18 21 24 MONTHS AFTER INJURY 34567 YEARS AFTER INJURY Figure 2. -- Time of First Epileptic Attack 25 345 YEARS AFTER INJURY 8 Flgur* Read the entire page →
From page 140... ... There have been a few references in the literature to the favorable prognosis of some posttraumatic epilepsies, although many authors, as Penfield (95) , have concluded that, once established, the prognosis was bad. Read the entire page →
From page 141... ... . Table 168. -- Medication Received by Men Having Major Attacks 3 to 6 Years After Injury Medication Year after injury Third Fourth Fifth Sixth Number of men with major attacks in this year . Read the entire page →
From page 142... ... Table 169. -- Medication Received by Men Having Minor Attacks 3 to 6 Years After Injury Medication Year after injury Third Fourth Fifth Sixth Number of men with minor attacks in this year 80 80 76 59 Medication -- total number of men Number 37 37 45 35 Phenobarbital < 3 grs 13 12 6 6 9 13 8 9 9 11 5 6 7 Phenobarbital ^>3 grs 7 5 8 Dilantin <4}£ grs Phenobarbital <3 grs. and Dilantin < VA ers . Read the entire page →
From page 143... ... Thus a wound of the frontal region on one side may be accompanied by a contusion of the ipsilateral temporal tip, contralateral occipital pole, or brainstem, any one of which sites might serve as a focus for an epilepsy. This multiplicity of cerebral wounding has been recognized for years, but its importance in the genesis of seizures having focal manifestations referable to cerebral aurae quite remote from the wound, even on the contralateral hemisphere, has not been adequately emphasized. Read the entire page →

From page 115...

... Such lightheaded spells or blackouts usually occur only in the first few days after cerebral concussion, but may be present for weeks or months, especially with more severe head injuries. Are they simply to be considered vasomotor phenomena or may they be epileptic?

Epilepsy Pages 115-144

Epilepsy
Pages 115-144