numerous observations, I maintain that the so-called epileptoid attacks form one of the most universal and commonest symptoms in the group of diseases which we reckon among the mental diseases and neuropathies; the mere appearance of one or more epileptic or epileptoid attacks is not decisive for its course and prognosis. As mentioned, I have used the concept of epileptoid in the widest sense for the attack itself.”[1]
The epileptoid moments of our case are not far to seek; the objection can, however, be raised that the colouring of the whole picture is hysterical in the extreme. Against this, however, it must be stated that every somnambulism is not eo ipso hysterical. Occasionally states occur in typical epilepsy which to experts seem fully parallel with somnambulic states,[2] or which can only be distinguished by the existence of genuine convulsions.[3]
As Diehl shows,[4] in neurasthenic mental deficiency crises also occur which often confuse the diagnosis. A definite presentation-content can even create a stereotyped repetition in the individual crisis. Lately Morchen has published a case of epileptoid neurasthenic twilight state.[5]
I am indebted to Professor Bleuler for the report of the following case:—
An educated gentleman of middle age—without epileptic antecedents—had exhausted himself by many years of over-strenuous mental work. Without other prodromal symptoms (such as depression, etc.) he attempted suicide during a holiday; in a peculiar twilight state he suddenly threw himself into the water from a bank, in sight of many persons. He was at once pulled out, and retained but a fleeting remembrance of the occurrence.
Bearing these observations in mind, neurasthenia must be allowed to account for a considerable share in the attacks
- ↑ C. Westphal, “Die Agoraphobie,” Arch. f. Psych., III. p. 158.
- ↑ Pick, Arch. f. Psych., XV. p. 202.
- ↑ Allgem. Zeitschr. f. Psych., XXI. p. 78.
- ↑ “Neurasthenische Krisen,” Münch. Med. Wochenschr., März, 1902, “When the patients first describe their crises they generally give a picture that makes us think of epileptic depression. I have often been deceived in this way.”
- ↑ Mörchen, “Ueber Dämmerzustäde,” Marburg, 1901, Fall. 32, p. 75.
