A Case of Epidural Intraspinal Abscess of Pyogenic Origin

W. J. Mixter
1916 Boston Medical and Surgical Journal  
sent. Eyes negative. All cranial nerves normal. Xo tremor. All tendon reflexes lively and equal. Cutaneous reflexes normal. No ataxia. Gait awkward with feet apart. Movements of hands awkward. Lower lip hangs down and mouth is open, while nares are not obstructed. Expression not alert. Eyes vacant. Does not pass mental tests suitable to age and environment. In this case there was probably trauma at birth, causing mental defect, but the epilepsy did not begin until the age of five, and it
more » ... five, and it followed the loss of the molar teeth. A young woman of twenty was operated on for appendicitis three years ago, and after the operation she suffered from constipation. All her upper molar teeth and upper incisors were artificial and supported by bridge work. A year ago, because of severe trifacial neuralgia the artificial teeth were removed, so that she could no longer chew her food. The neuralgia was not relieved, and soon after losing the teeth she had an epileptic attack, and she has had three other attacks since then. The work of having the teeth of these patients repaired proceeds very slowly, but at some future time I hope to report the results, if any, thus obtained. At this time it can only be said that those patients who have had the work done are doing well. When there is difficulty in making a diagnosis between epilepsy and hysteria, or between epilepsy and intracranial tumor, a bad condition of the teeth, in which the chewing surface is inadequate, is evidence in favor of epilepsy. Epilepsy is rare in breast-fed infants, and it does not often occur before the age of eighteen months. In another series of fifty epileptic children under twelve years of age, the writer found that in only seven it began before the age of one year, while in twenty it began between the ages of one and two, and in only twentythree did it begin during the long period from two until twelve. Therefore, epilepsy in childhood usually begins at the time when the child is beginning to eat solid food that requires chewing, and when the teeth are often not sufficiently developed to do the work. In four of this series of epileptic children there was spastic paralysis, demonstrating injury to the brain, but the four were all feeble-minded, and gavo the usual history of gourmandiziug and bolting of food, which the writer believes accounts for epilepsy in the feeble-minded. Epilepsy resembles tuberculosis in having no specific cure, and it should be treated, like tuberculosis, by common-sense methods, with close attention to detail. It has to be regarded at pnce from the viewpoint of the neurologist and from that of the general practitioner. Three years ago the writer suggested intestinal surgery in some cases of epilepsy, but he has seldom been compelled to advise surgery, because good results can be obtained without it, and in the majority of cases the dentist, rather than the surgeon, should be consulted.4 The prognosis in many cases of epilepsy depends largely upon the possibility of repairing the teeth. The series of fifty cases is, of course, too small to prove that eighty per cent, of all epileptics have bad teeth, but if in a larger series the percentage were to differ by twenty-five with the percentage in my series, it would still show the majority of epileptics to have bad teeth. Most of my patients have been children, and in a series of adults the percentage having bad teeth would probably be higher. The series of over 300 cases, in every one of which digestive disturbances preceded the epilepsy is, I believe, large enough to answer conclusively the question of whether the visceral changes found in epileptics at autopsy are primary or secondary.0 1 am indebted to Drs. J. J. Thomas and A. W. Fairbanks for the use of the material in the Children's Hospital, where about oue-third of the cases were seen.
doi:10.1056/nejm191612141752405 fatcat:ji7k7qxnmbfepi2geitidy4vpy