A system of practical medicine . gestive theory, I feel that from the practical point ofview we must consider epileptic convulsions as having their seat of originin the cortex. The primary seat of the discharge which ultimatelyaffects the motor areas may be an irritation in any part of the cortex, 486 EPILEPSY. whence it may extend by irradiation to the Rolandic areas. In psychicepilepsy probably it is the frontal cortex which is implicated. In casesof convulsive seizures, preceded by aurse of various kinds, doubtless theoriginal site of the discharge is in the cortical centres for the functio
A system of practical medicine . gestive theory, I feel that from the practical point ofview we must consider epileptic convulsions as having their seat of originin the cortex. The primary seat of the discharge which ultimatelyaffects the motor areas may be an irritation in any part of the cortex, 486 EPILEPSY. whence it may extend by irradiation to the Rolandic areas. In psychicepilepsy probably it is the frontal cortex which is implicated. In casesof convulsive seizures, preceded by aurse of various kinds, doubtless theoriginal site of the discharge is in the cortical centres for the functionsrepresented in the particular premonitions in each case. Some authorsare inclined to believe in a convulsive centre in the floor of the fourthventricle. Jackson considers laryngismus stridulus a convulsive dis-charge from the ponto-bulbar region, as also the respiratory fits inducedin animals by asphyxia, the attacks produced by convulsant poisons(urea, camphor, curare, absinthe, nitrous oxide, and the like), and such Fig. Dentition,reflex etc. Facial muscles Reflexes from peripheral Mnerves and viscera To muscles of trunk,arms, and legs Schematic representation of the two convulsive centres, one cortical, the other ponto-bulbar,which may be acted upon by direct lesions or by toxic blood states ; or occasionally by reflexirritations conveyed along sensory fibres from distant parts of the body. as result from injuries to the sciatic nerve and spinal cord in following diagram (Fig. 59), from my article on Infantile Convul-sions in the American Text-book of Diseases of Children (p. 742), illus-trates the two convulsive centres—the ponto-bulbar and the cortical—together with their relations and connections, and shows how directlesions may affect them, how reflex stimuli may be conveyed to thera^and how they may be irritated by vascular or blood states. Assuming that the cortex contains the cpileptogenetic centres, thecause of the irritation inducing the a
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