Epilepsy : a study of the idiopathic disease.

  • Turner, William Aldren, 1864-1945.
Date:
1907
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Licence: In copyright

Credit: Epilepsy : a study of the idiopathic disease. Source: Wellcome Collection.

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    described his observations in the chapter upon Pathology con- tained in this volume. The changes, which he has observed and recorded, consist in the formation of coagula in the veins, capillaries, and arterioles of the cerebrum and cerebellum. The clots appear to be formed by the accumulation and amalgamation of blood plates. Suitable staining reagents show that these coagula contain phosphorus, probably as a constituent of their nucleo-proteid. These clots eventually undergo degenerative changes, and in process of time become absorbed. The chief effect of these thromboses, which are formed extensively through- out the brain, is to deprive the cortical grey matter of the arterial blood necessary for its proper function, and to induce a condition of blood stasis. If the coagulation and obstruction occur in the veins, as is commonly the case, the same result is brought about as if they occurred in the arterioles, viz., arrest of the arterial blood supply to the corresponding cortical area. Apparently, as a result of the deprivation of arterial blood, the large pyramidal cells of Betz show characteristic alterations, such as a large, swollen and clear nucleus, similar to what has been described by Mott,1 from the experiments performed by Hill upon ligature of the carotid arteries in dogs, to which reference has already been made. As a result of these observations, Dr. John Turner is of opinion that convulsions would appear to be due to the deprivation of arterial blood in cortical areas, coincid- ing with capillary and venous stasis, in persons hereditarily pre- disposed to nervous instability. There are certain facts which would favour this view as a not unlikely explanation of some convulsive seizures occurring in epilepsy. First, the marked frequency of epileptic fits at night, especially during the hour or two immediately after falling off to sleep, when the cerebral blood-pressure is at its lowest; and, secondly, the frequency of epileptic fits of a severe character in association with acute infective disorders, such as pneumonia, enteric and scarlet fevers, in which there is an increased coagulability of the blood and a tendency to venous thrombosis. In this category also may be placed the puer- perium—a period which is notoriously prone to the incidence of epileptic fits. The consideration of this subject leads on to the possible production of some fits by a state of autointoxication—a cause 1 Mott, Croonian Lectures, 1900.