Changing Conceptions of Epilepsy

PRESENT-DAY research in respect of epilepsy is concerning itself principally with the experimental induction of fits, with discovery of the physicochemical changes accompanying them, and with their control by other methods than the purely medicinal. The result is that timeworn theories are undergoing revision, but less attention is being devoted to underlying questions as to the meaning of the term, the limitations of the disorder, and the inclusion or exclusion of certain types of clinical phenomena. The traditional view is based on the contention that a disease called epilepsy exists, its salient symptom being the occasional fit. This disease is alleged to be progressive, rather intractable, and prone to result in mental deterioration. Its cause being unknown, it is labelled' idiopathic,' in contrast with well-recognized morbid states often disclosed by similar fits, e.g. cerebral vascular disease, brain tumour, encephalitis, and so forth. But we may think it curious that the patently symptomatic nature of many types of fit has not yet sufficed to rouse suspicion as to the ' idiopathic ' variety-at least, not universally; the untenable character of the 'idiopathic' hypothesis has convinced some but not all observers. Those who do not like the term sometimes use the expression ' genuine' or ' essential ' to characterize the ' disease,' as though fits of a symptomatic kind were merely casual or in some unexplained way 'false.' The best present-day opinion is none the less veering round in the direction of affirming that all epilepsies are symptomatic, inclusive of that variety whose basis still eludes search, and that since some causes are known the cause of the latter will eventually be revealed in its turn. Instead of the term ' epilepsies ' it might be preferable to employ alternatives of more non-committal nature, e.g. 'paroxysmal disorders' or ' convulsive states '-a series of diverse conditions linked together by the occasional occurrence of ' fits,' but at the risk of perpetuating notions inherited from a less well-informed era the word will doubtless continue in vogue. For didactic purposes, too, it may be temporarily expedient to differentiate