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epilepsy attack symptoms

it has been recognized there occasionally occur conditions which stimulate attacks of real epilepsy. On close analysis, however, it is found that these attacks have only a superficial resemblance to epilepsy, and that they are purely functional in nature. In all probability such conditions represent certain types of dissociations of consciousness. These attacks are known as psycho-epilepsy, a name which indicates the purely psychical and functional nature of the attacks and their differentiation from true, organic epilepsy. Whether the condition should be classed under hysteria, or as an episode in the course of a psychasthenic neurosis, is still an open question. The subject is an important one, however, because accounts are frequently published by the medico-religious cults and others, of the cure of epilepsy through purely psychotherapeutic methods. These so-called epileptic attacks are undoubtedly of a psychoepileptic character, as genuine epilepsy is an organic disease which only simulates a functional disorder and which does not yield to any form of psychotherapy.

These psycho-epileptic attacks seem to be of several varieties. They may take the form of genuine convulsions, so far as the outward appearance is concerned, these convulsions being either general or more rarely limited to a special part of the body. In one of my cases, the right arm alone was involved in the psychoepileptic attack and the purely functional nature of the disorder was proven through a searching analysis of the condition and its final cure through psychotherapeutic methods. In other conditions the attack may consist of a momentary confusion, intense anxiety, or even a feeling of depersonalization. This type may or may not be associated with a sense of unreality. One patient described his condition “as if my personality was gone. I see, hear, walk, converse, my mentality goes on, but the thing I call I, is changed.” There is still a third form which these attacks seem to assume, a form which can be clearly differentiated from the other two. Here the attacks consist of peculiar momentary feelings of depression or numbness, without any loss or diminution of consciousness, and passing in a wave-like manner from one portion of the body to the other. Here the associated mental state is either anxiety, depression, or fear. Now the important question arises—how can we distinguish these conditions from genuine epilepsy? When we come to consider the convulsions, we find that there is usually no history of epilepsy or fainting attacks in early youth. The attacks may be induced by emotional stress or mental or physical exertion. The seizures are of the nature of states of mental dissociation, which recur automatically and have an independent activity. The genesis of the individual attacks is  usually  some emotional experience.

Furthermore, the memory for the attacks is only apparently lost and may be recovered through appropriate psychological methods, either in its entirety or as isolated fragments. So far as my experience with amnesia is concerned, it is almost impossible to restore the amnesic periods in genuine, organic epilepsy. Finally, most important of all, it is possible to reproduce an attack automatically. In one case in which the fit consisted of a spasm of the left arm, an attack was reproduced when the subject was placed in a state of abstraction. There is never an impairment of intellect or memory in these conditions, no matter how frequent the attacks may be, whereas one of the important signs of genuine epilepsy is a gradual deterioration of the intellect and memory. When the attacks consist merely of periodic anxiety and depression they can frequently be reproduced at will by allowing the mind to dwell upon the attacks and can even be prevented by directing the mind along other  channels.  The feeling  of depersonalization, of unreality, the possibility of artificial reproduction of the attacks and of the artificial recovery of the amnesic period.

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