Traumatic epilepsy does not always partake of the typical Jacksonian type. Sometimes the fits are so sudden in onset and violent in character that, from the first, the more typical features are absent. Again, fits of the focal or Jacksonian type do not necessarily imply that some pathological causative agent will be found on exploration. Ordinary epilepsy sometimes partakes of the focal type. I have myself operated on three cases of focal epilepsy, deceived by their Jacksonian characteristics, and found nothing abnormal. On the other hand, in all these cases definite and permanent improvement was observed subsequent to the surgical procedures.
It might also be added that encouraging reports are to hand, not only in cases of idiopathic epilepsy with focal symptoms, but also in cases without focal symptoms. A decompression operation is carried out on the basis of Kocher’s statement to the effect that the fit is immediately preceded by a rise of intracranial pressure, for which a safety-valve must be supplied--such as is afforded by an intermusculo-temporal operation of decompression. Whether Kocher’s statement is correct or not, the fact remains that some cases of idiopathic epilepsy, without focal symptoms, benefit considerably from operation.
=The localizing symptoms of traumatic epilepsy.= When the cause of the trouble is situated over the motor area--the pre-Rolandic cortical strip--the fits should commence by twitchings of the fingers, toes, corners of the mouth, &c., according to the site of the lesion. The fits are seldom preceded by any sensory auræ, though occasionally such may be the case, for even at the present day some doubt exists as to whether the precentral area should be regarded as purely motor or sensori-motor. In other cases, the patient, without being able to state definitely his sensations previous to the onset of the fit, may be able to foretell its immediate development, and still more rarely he may be capable of aborting the fit or diminishing its intensity by grasping firmly or massaging the region of the body in which the fit first develops.
When Broca’s motor speech-area is primarily involved, the fits are preceded by difficulty in phonation, mumbling of words and incoherence, grinding of the teeth, &c., the fits then rapidly spreading to the parts responsible for the movements of the muscles of face and upper extremity.
