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September 23, 1922


JAMA. 1922;79(13):1009-1014. doi:10.1001/jama.1922.02640130001001

That, after thousands of years of familiarity with epilepsy, the diagnosis should still sometimes be difficult and mistakes not infrequent, may seem anomalous.

But it is true. The principal difficulties are three:

  1. Uncertainty as to what constitutes epilepsy.

  2. Polymorphism of the disease.

  3. Necessary lack of observation. Ordinarily the diagnosis must be made from statements of the patient and of others.

The first difficulty we shall not consider. What we mean by epilepsy is the disease or disorder described as such by most standard authors. Meticulous nosology is no part of our present theme. Obviously, a systematic discussion of diagnosis is impossible. Our private records of more than a thousand cases show that epilepsy had to be differentiated from the following thirty conditions: hysteria, psychasthenia, brain tumor, syphilis, apoplexy and hypertension, encephalitis, dementia praecox, melancholia, Stokes-Adams disease, spasmophilia, migraine, nephritis, feeblemindedness, general paresis, multiple sclerosis, polycythemia, anemia, tic, chorea, fainting spells,