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War Surgery and Medicine

EPILEPSY

EPILEPSY

In the survey of 953 cases made by Dr. Macdonald Wilson only 60 cases developed epilepsy—16 from simple concussion, 10 from accidental fractures, and 34 from penetrating wounds in battle. As it is inconceivable that any man with fits should not have applied for a pension, the figures are doubtless very accurate, and New Zealand's isolated and small population makes it much easier to page 159 obtain accurate figures of this kind. As there were only 16 cases at the end of 1950 still suffering from fits due to penetrating missiles, the problem is not a very serious one.

Fractures of Skull due to Penetrating Missiles

The results show that injury to the brain tissue is the usual precursor of epilepsy following war wounds. An incidence of 17.3 per cent (34 cases out of 196) has occurred with penetrating wounds of the skull involving fracture. By the middle of 1950 there had been 2 deaths and only 16 were then having epileptic seizures. Thus the incidence had been nearly halved.

The group has been classified:

Year of Injury Number Suffered from Fits Continued to Suffer, 1950
1940 2 1 1
1941 32 7 5
1942 35 6 1 (2 died in seizures)
1943 37 5 1
1944 65 9 7
1945 25 6 1
—— —— ——
196 34* 16

Of the 3 cases with intact dura, 2 continue to have fits, while the third case, wounded in 1945, ceased to have fits in 1947.

Forty-seven cases had either retained metal foreign bodies or bone fragments within the brain, and eleven, or 23.4 per cent, have developed epilepsy. Of the 149 cases without retained foreign bodies or bone fragments 23, or 15.5 per cent, had developed epilepsy. Of the 16 cases which had ceased to have fits, 7 had, and 9 had not, retained foreign bodies within the brain. Those still having fits, including 2 dying in seizures, were 4 with retained bodies (8.5 per cent) and 14 without (9.6 per cent).

Accidental Fractures of the Skull without Penetration of the Brain

Of the 157 cases, 130 occurred during service, and with these were associated seven cases of epilepsy, all arising from vertex fractures which had been operated on for the removal of depressed bone. Two cases had ceased to have fits, one two years after injury and the other four years after. The fits commenced in two cases within the year, in one case in the second year, in two cases in the third year, and in two cases after three years.

In three cases history was given of pre-service injury and fits.

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Cerebral Concussion

In the 16 cases associated with cerebral concussion the relation between the alleged head injury and the fits was in most cases very obscure. There was often very slight injury and again a long period of years before the onset of epilepsy. Only four of the cases started within a year of injury, and unless epilepsy occurred soon after a very definite concussion there appeared no reason to associate the two conditions. Three of the cases died of cerebral tumour.

* 31 of the 34 suffered penetration of the dura.