Case report: reflex epilepsy and peripheral injury.

In discussing the significance of reflex epilepsy Critchley (1933) stated that an incoming stimulus would hardly provoke convulsive phenomena unless there was a state of supercharge in the central nervous system. Holmes (1927) described cases in which a cortical lesion apparently caused the disturbed peripheral response to a specific stimulus, and he considered that the appropriate external stimulus may excite epileptic symptoms if the corresponding part of the cortex is in an unstable state. A number of the cases in Critchley's series were associated with severe structural changes in the brain, and he also quotes a case of Rosenhain's in which attacks were precipitated by irritating the stump of an amputated finger, a necropsy eventually showing a tumour of the parietal lobe of the opposite hemisphere. Dawson (1947) has since shown experimentally that a peripheral stimulus can produce an electrical response over the contralateral cortex. The association between the epileptic response and peripheral injury in some cases of reflex epilepsy has been reviewed recently by Parsons-Smith (1948) who added a case of his own. This was the case of a man who had cerebral cysticercosis and subsequently sustained a peripheral nerve injury, after which focal and generalized fits were precipitated by the passage of a stimulus through the injured peripheral nerve. The following case also shows evidence of abnormal cortical function and peripheral nerve injury but differs from Parsons-Smith's case in that the patient suffered from traumatic epilepsy for many years before he sustained the peripheral injury which led to the development of reflex fits.