. Epilepsy, a study of the idiopathic disease. some status periods present a sudden onset, which are,according to Clark, almost invariably due to arrest of sedativetreatment, although this is by no means the only cause ofsuddenly developed status. With the development of the status period convulsive attacksbegin to follow each other with considerable rapidity, each attackbeing complete with its after-stage, consciousness being at firstregained; but as the interparoxysmal periods shorten, thecomatose stage is prolonged, and the seizures, increasing in ^ The number of fits that may occur in any
. Epilepsy, a study of the idiopathic disease. some status periods present a sudden onset, which are,according to Clark, almost invariably due to arrest of sedativetreatment, although this is by no means the only cause ofsuddenly developed status. With the development of the status period convulsive attacksbegin to follow each other with considerable rapidity, each attackbeing complete with its after-stage, consciousness being at firstregained; but as the interparoxysmal periods shorten, thecomatose stage is prolonged, and the seizures, increasing in ^ The number of fits that may occur in any given time in epilepsy is amatter of some interest. Clark refers to a case of Leroys in which therewere 488 fits in twenty-four hours, and 1000 in three days ; and to one ofParsons with 1400 attacks in four weeks. I have myself seen 2080 in eightweeks, 673 in ten days, 820 in five days, and as many as 289 in twenty-fourhours. CHART 5. An Illustration of the Combined Type of Epilepsy. JAN. FEB. MAR. APRIL MAY JUNE JULY AUG. SEP. OCT. NOV. To face page i02. R. eOin STATUS EPILEPTICUS 103 frequency, eventually induce a state of continued clonic spasm,the final convulsions of the preceding seizure having scarcelydied away before those heralding the approach of the nextcommence. From this, which may be looked upon as the apexof the period, the spasms begin to diminish in frequency, so thattowards the termination of this stage single isolated spasms maybe the sole representatives of the paroxysms. Now ensues theconvulsionless after-stage of continued coma, stupor, and exhaus-tion, in which the patient may die. This stage is characterisedby the usual phenomena of coma from other causes; stertorousbreathing, a cold clammy skin, the involuntary voiding of urineand foeces, abolition of the tendon reflexes, an extensor plantarreflex, elevation of temperature, sometimes to hyperpyrexia andincreased pulse rate. Occasionally during this stage, isolatedconvulsive paroxys
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