On convulsive seizures / by J. Hughlings Jackson.

  • Jackson, J. Hughlings (John Hughlings), 1835-1911.
Date:
[1890]
Catalogue details

Licence: Public Domain Mark

Credit: On convulsive seizures / by J. Hughlings Jackson. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

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    kinds in an order different from that used in stating the levels, (2) I mention epileptiform seizures first because their localisation is not doubtful. (They were first described by Bravais in 1824.) They are “middle level fits”—that is, they are produced by excessive discharges beginning in parts of the middle level (motor province) of the cerebral system (“ motor region ”). My hypo- thesis is that (3) fits of epilepsy proper (“genuine epilepsy ” of some nosologists) are “ highest level fits,” and that many of them, not all, are produced by excessive discharges beginning in parts of the praefrontal lobes, highest level (motor province) of the cerebral system. Although the prefrontal lobes are not experi- mentally excitable, I suppose it will not be denied that their cells katabolise and liberate energy in their normal activities, and it is not unreasonable to suppose that cells of parts of them may, by pathological changes, become highly explosive, so that they occa- sionally discharge excessively. So that, if the prsefrontal lobes are divisions of the “ intellectual centres,” as no doubt they are, and not, as I think, motor too, excessive discharge beginning in parts of them may produce epileptic fits. Of course, this is speculative. 1 am not aware that anyone pre- tends to know the seat or the pathology of cases of “ genuine epi- lepsy.” I do not use the term “ cortical epilepsy,” because both epilepfoc and epileptiform seizures are, to my thinking, cortical fits. (The difference in meaning assigned to the two terms epi- leptic and epileptiform must never be lost sight of.) (1) I think that there are “ lowest level fits.” These are fits produced by ex- cessive discharges beginning in parts of the lowest level, a level which is common to the cerebral and the cerebellar systems. I suppose that most of them are owing to excessive discharges beginning in centres of the bulbar and pontal regions of the level, hence I sometimes use the term “ ponto-bulbar fits.” With regard to epileptiform and epileptic fits, I deal almost exclusively with cases of patients subject to fits—with, so to speak, “ chronic cases.” I have so far spoken only of three Kinds of fits. No doubt there are Varieties of each kind. Whilst tbe kind answers to the level, the variety of each kind answers to the particular part of the level in which the excessive discharge begins. It is certain that there are varieties of (2) epileptiform seizures ; each is marked by a particular place of onset of the convulsion. There must be at least as many varieties of (3) epilepsy proper as there are different “ warnings ” of the paroxysms. Presumably there are varieties of (1) ponto-bulbar fits. Then, of course, there are Degrees of each variety dependent directly on degree of the primary discharge, and indirectly on that of the secondary discharges. (2) For example, there are degrees of that variety of epileptiform seizures marked by the first spasm being of the thumb. There are many ranges of it,from convulsion almost limited to a thumb, thence onward to universal convul- sion. (3) Everybody recognises that epileptic attacks occur in two vastly different degrees, les petits maux and les grand maux, a id there are sub-degrees of each of these degrees. (1) There are degrees of convulsion in lowest level fits produced by Brown- S6quard’s method iu guinea-pigs. There are, no doubt, degrees of respiratory fits produced in certain lower animals by rapid bleed- ing, by ligature of the great arteries of the neck, and by sudden stoppage of respiration. To repeat, “ fit ” is a term used to include convulsive paroxysms of all kinds dependent on excessive discharges beginning in any part of any one of the three levels, the epileptic and epileptiform