Convulsions appearing for the first time late in life may presage the appearance of the more obvious manifestations of progressive brain damage by tumors, vascular disease, or degenerative diseases. It has therefore become current teaching that, when seizures develop in adulthood, they are usually expressions of some serious underlying disease with grave prognostic implications.1 This has led to a justifiable attitude that the appearance of seizures warrants a careful search to detect the structural lesion responsible for the seizures. The frequent failure to discover the etiological agent, however, leaves the physician with a disquieting uncertainty as to whether there still remains some destructive process that his diagnostic methods have failed to uncover.
The basic studies for the work-up of patients who develop seizures usually consist of a complete neurological examination, spinal tap, x-ray examination of the skull, and electroencephalogram, in addition to the procedures to determine the general physical
Berlin L. SIGNIFICANCE OF GRAND MAL SEIZURES DEVELOPING IN PATIENTS OVER THIRTY-FIVE YEARS OF AGE. JAMA. 1953;152(9):794–797. doi:10.1001/jama.1953.03690090018005