Visceral Manifestations of Epilepsy

The generalized convulsion or grand mal attack of epilepsy usually presents such a striking picture of somatic motor phenomena that signs and symptoms involving visceral and other autonomic functions, while present, are overshadowed. Within the grand mal seizure there usually occur cardiorespiratory, gastro-intestinal, urinary, and other autonomic symptoms. Prior to a grand mal seizure there may be a visceral aura. This is often an epigastric or abdominal sensation and may occur in as often as 20 per cent of the patients. During a grand mal seizure patients become cyanotic, have disordered respirations, tachycardia, occasional vomiting, involuntary defecation and urination, sweating, increase in blood pressure and pupillary changes. Some of these symptoms may persist after the main portion of the seizure, and there may be a fever, especially in children. Aside from these manifestations, occurring in some relation to a grand mal seizure, there are many instances of visceral phenomena representing in themselves the major portion of a seizure state. These often occur in patients with seizures in the psychomotor group. Psychomotor seizures are characterized usually by auras of anxiety and visceral symptoms followed by alterations in consciousness associated with many varied complex feeling and thinking states and automatic somatic and autonomic motor behavior. These phenomena are associated with at least a partial amnesia. In many instances a sequence of motor events may occur, evolving in brief phases. First, there may be arrest or suspension of activity with perhaps a simple nonrepetitive movement. This is followed by repetitive, stereotyped automatisms with little variation from seizure to seizure such as swallowing, sucking or chewing, and movements of the arms and legs. The third phase consists of automatic acts of varying complexity often associated with visceral symptoms. These automatic acts are semipurposeful, usually inappropriate, bizarre, involving an interplay with the environment and determined in part by psychological factors. The activities in this latter phase often may appear to merge into normal behavior. This type of seizure complex