Epilepsy, comparative pathogenesis, symptoms, treatment / [Louis Jacob Josef Muskens].

  • Muskens, L. J. J. (Louis Jacob Josef), 1872-1937.
Date:
1928
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Licence: In copyright

Credit: Epilepsy, comparative pathogenesis, symptoms, treatment / [Louis Jacob Josef Muskens]. Source: Wellcome Collection.

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    numerous further operative treatment was inadvisable lest “ the condition might get worse.” The patient now began to show psychical changes. A year later she was brought back to see me through the agency of a charitable institution. Examination of Patient : Family History.—No history of any nervous disease. On examination of patient’s shaven head a well-marked star-shaped scar was seen inside the scar of the Wagner flap over the left parietal region. It was noticeable that the right hand was very backward in development as contrasted with the left. Tested with the dynamometer, the right hand registered 42, while the left registered 62. Testing of the right hand showed that the finger-nose test was perfect. She could recognise small objects placed in the right hand, her eyes being shut. There was no disturbance of tactile or painful sensations, but she was unable to Fig. 46.—On the Skull is shown a Horseshoe-shaped Scar of the Wagner Flap used in the Second Operation in the Binnen- Gasthuis. Within this scar is another scar, which was caused by the original injury and the operation which was performed immediately after. recognise passive movements, bending and stretching, of the right index finger. Sensations of passive movements of the joints of the hand were in other respects normal. The deep reflexes were found normal on the left side, exaggerated on the right. In my first operation (Dr. Oidtmann assisting with Dr. Philips as anaesthetist) the Wagner flap and deformed piece of bone left from the earlier operations were removed. There was no improvement, the fits continued as they had done for years. After six weeks a second operation was performed. This time the dura mater was freely exposed, and a macerated opening found in it. Just inside this opening two small splinters of the vitreous lamina were found lying on the cerebral cortex; these were removed (see Fig. 47). No improvement followed this operation. A final operation was performed. The brain was exposed as before, and with a bipolar electrode and a weak faradic current stimulation was applied over this part of the cortex. It was found that epileptic fits were