A case of epilepsy

By | August 17, 2015

By S. A. Kimball

April 9, 1889. -Miss G-, a seamstress, 44 years of age, of medium size, dark hair, came to my office with the following history; She has been having epileptiform attacks for the last eight years, almost every month. The first attack came on after seeing an old lady fatally injured by falling down an elevator well at a house where she was working. This was in February and the first convulsion occurred the following August, she having been in a very excitable, nervous condition since her accident.

Her father was a drunkard, her mother and eldest sister died of phthisis. Her present condition is as follows, some information being obtained from friends: The attacks usually come before or during the menses; they are apt to be induced from any over-excitement or in an overheated room; she can not bear heat; the blood rushes to her head. Two or three days before an attack her head feels badly, as if all the blood were in the vertex; it burns and feels hot. There is almost always an aura, a sizzling in the fore part of the head; sometimes, however, there will be no warning at all, as is shown by several scars on her forehead where she has struck herself in falling, and at the time of this visit, her left eye and temple are black and blue from falling on the stove.

During the attack, the convulsive movements are mostly in the lower limbs; she bites her tongue, making it bleed and very sore, but does not forth much at the mouth. She often passes urine during the fit and sometimes has an involuntary stool.  After the fit she has a long, heavy sleep, and when she awakes her abdomen is very sore.

She began to menstruate when eleven or thirteen years old, and has always been regular but scanty, the flow lasting but three days. Before menses, her head feels badly. During menses the flow relieves her head. She sometimes has a pain in lower back. Last summer, she did not menstruate for three months, and her head felt badly all the time. Since then she has been regular not scanty. Her appetite is good and bowels regular. Face flushed. Tongue trembles on putting it out. She can not bear anything tight about neck, must have everything loose. Her legs go to sleep occasionally, usually the left. Memory impaired. Can not remember dates or numbers and she has a rather dull, stupid expression. Her last menses came March 26; two days before she had a convulsion without any waning and fell against the corner of the stove, striking the left eye and temple and causing the black and blue mark before mentioned. This shows that she fell toward the left side. She has been taking bromides off and on for four years without any effect, and has lately been to a homeopathic dispensary without relief.

The symptoms point to but one remedy, the heat and burning of the vertex, the regular but scanty menstruation, the relief by the flow of all head symptoms before menstruating, the inability to bear anything tight about the neck, the trembling of the tongue on putting it out; all these, with the general left-sided tendency of the symptoms, point unmistakably to Lachesis, and she received one dose dry of Lachesis cm.

May 30: Not as much discharge as usual. No convulsion before, no congestion to head before. Tongue does not tremble as much on putting it out. Face still flushed and she can not bear anything tight about neck. Thanks she remembers better, is much more cheerful and feels very well. Sac. lac.

June 25: Last menses came all right, no trouble, no convulsion. Is away for the summer at Williamstown, Mass. Sac. lac.

July 22: Has been quiet well; last menses all right; no convulsions. Writes that she can not remember of being so free from trouble with her head as she is now. Sac. lac.

August 21. -Writes that she has the same story to tell; menses all right, no return of the convulsions. Sac. lac.

Sept. 17-Writes that everything has been all right this month. Sac. lac.

Oct. 21. -Returned last week from Williamstown, where she has been for the summer. She looks very well, and says she has not been as well for years. Menses have been regular; no headache. Once or twice this summer she has had a slight vertigo, and once a little pain in the back of the head. She appears very calm, not at all nervous. Good color, appetite good; legs do not go to sleep. Sac. lac.

January 16, 1890. -Has had no convulsions. In December she had an attack of congestion to the head with vertigo and nausea. She has had “la grippe,” with pains and aching all over. She was very weak after it, but has taken no medicine, and now feels very well. Sac. lac.

February 4. -She had a convulsion, January 24, two days before menstruation. She was sewing in a cold room and her feet were very cold, she became unconscious without warning, and on “coming to” found herself on the floor. She does not know how long she was in that condition; but it was probably a mild convulsion as there was no biting of the tongue, no involuntary stool or urine and no sleepiness after the fit, but she finished her day’s work and went home as usual. Menses came two days after, January 26, without pain. Her head had been feeling badly before the convulsion, but feels all right now. This was the first convulsion since March 24, an interval of ten months. The reaction of the vital force in a direction toward health which was set in motion by the dose of Lachesis given April 9, 1889, had evidently lost its forward impetus and was beginning to be overcome or go backwards, under the influence of the increasing abnormal condition. This retrograde action began the preceding month in December, as was shown by the attack of vertigo and nausea, and was increasing in force as shown by the convulsion of January 24. No doubt “la grippe” was to some extent responsible for this, as it interfered very seriously with treatment of chronic patients. It now seemed necessary in order to give another impulse to the reactive power of the vital force that either a new remedy should be selected or the last one repeated. A careful review of the case disclosed the same general condition as at the first examination, although much modified, and many symptoms entirely gone. There being no indications for a new remedy, she received another dose of Lachesis cm.

March 4. Menses came February 25. No convulsion, but for a week before menstruation she had a sharp pain in the back of the head extending to between the shoulders, and considerable pain in the teeth of the right lower jaw. There was no pain after the flow began, which lasted four or five days and was about normal in quantity; this was an increase in the length of time and amount over her usual condition. Sac. lac.

April 1. -Menses came March 24. No pain or convulsion before. The flow lasted four days; feels very well. Sac. lac.

June 11. Menses, April 22. Head felt badly two days before, with vertigo and rush of blood to the head, but no convulsion, and she was entirely relieved as soon as the flow began. The next period came May 22d. No trouble with head before menses; no convulsion, no pain during. She is now in excellent health and about to go away for the summer. Sac. Lac.

There can not be much doubt that this is a true epilepsy, the only disease of a convulsive nature that would require differentiation is hystero-epilepsy. In this latter affection the patients rarely injure themselves in falling, the attacks seem to have no effect upon their mental or physical condition, the tongue is not bitten, and the convulsions are marked by periods and phases. I can not find that such attacks are attended by involuntary stool or urine. All of these symptoms were present in a marked degree in my patient, with complete loss of consciousness and deep heavy sleep after the fit, but I do not know whether there was a rise of temperature during the convulsion, which is regarded by some authors as a strong diagnostic point for true epilepsy in doubtful cases.

This case is not given as an instance of a cure of an epilepsy-two or three years immunity from convulsions would be necessary to insure that-but the decreasing of the number of convulsions from one every month to one in fourteen months promises well for a complete cure. It also seemed worthy of note as well illustrating the effect of the action of a properly selected remedy upon the vital force when compared to the oscillations of a pendulum. We have the long swing toward health of eight months from April to December, 1889, the backward swing of two months to the convulsion of January 24, 1890, then the forward swing of two months to April, then the slight backward swing of one month, as shown in April by the vertigo and rush of blood to the head, then the onward swing toward health to a state of rest which is now continuing, and which, it is hoped, will be lasting.