On convulsive seizures / by J. Hughlings Jackson.

  • John Hughlings Jackson
Date:
[1890]
Catalogue details

Licence: Public Domain Mark

Credit: On convulsive seizures / by J. Hughlings Jackson. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

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    —loss of a very few complex movements. I shall here ignore this slight inferential paralysis, and speak of such cases asj “ un- complicated.” The term post-epileptiform paralysis will be used to include all paralyses the immediate sequels of epileptiform seizures. Arbit- rary divisions may be made, speaking of range only. (1) Terminal paralysis, as of a hand; (2) monoplegia, as of an arm ; (3) hemi- plegia ; and (4) a range .which is not generally admitted—some degree of slight universal paralysis. I hold the hypothesis (essen- tially that of Todd and Alexander Robertson) that there is ex- haustion of central nervous elements, including fibres of the second segment of the kinetic route, and that this is produced by the sudden and excessive discharge in the prior paroxysms These nervous elements are exhausted, not otherwise injured, so that recuperation is prompt, and the corresponding paralysis is temporary. There is a sequence of two opposite functional states, superpositive of the first degree (a) in the paroxysm, and then, after the paroxysm, negative. But there is often more than a negative functional state in the post-epileptiform condition. We may find increased tendon reactions implying a superfunctional state of the second degree (6) of lowest motor centres. The duplex nature of these post-epileptiform conditions must be borne well in mind. The term “exhaustion” has been objected to; general bodily prostration is, of course, not meant; but, as said, exhaustion of nervous elements in a particular part of the central kinetic route. There are, I suppose, degrees of exhaustion, and no doubt of different numbers of nervous elements of the kinetic route in different cases. But illustrating by the extremest degree, the sup- position is that nervous elements of the route, after their excessive “exercise”in the fit, are left “fatigued” to the degree of utter impotence. The nervous elements exhausted in post-epileptiform paralysis are, I suppose, in the same state as are the motor nerve fibres of the sciatic nerve going to the cut-off leg of a frog after strong faradisation of that nerve trunk ; the leg is convulsed by the faradisation (stage analogous to epileptiform seizure), and is next paralysed (stage analogous to post-epileptiform paralysis) because its motor fibres are exhausted by the unnaturally high functioning they have been artiflcally compelled into. A closer analogy may be stated, although the case to be instanced is a com- plicated one. The motor nerves of a frog, poisoned by a very large dose of strychnine, lose function partly by the direct action upon them of that poison, but partly (this is what is relevant) through exhaustion—“the exhaustion of over-use due to the intense activity of the nerve during the stage of spasm.”52 Not only the term, but the hypothesis itself is objected to. I will consider other hypotheses. The paralysis has been ascribed to cerebral congestion consequent on arrest of respiration in the preceding seizure. It is difficult to see how cerebral congestion, even if we grant that it can produce paralysis, could be so ex- quisitely local as to produce what we sometimes observe, paralysis of one arm only, or even of but part of one. Again, absolute para- lysis of a limb is found after seizures nearly limited to that limb, in which seizures there was no arrest of respiration and (if that is thought to bear on the question) no loss nor even defect of con- sciousness ; the patient may talk throughout an attack in which an arm is involved, and after which it is temporarily paralysed. There is the hypothesis that the temporary post-epileptiform para- lysis is owing to a small extravasation of blood in the brain, *a See Wood’s Therapeutics, 7th edition, pp. 258-9.