EPILEPSY. - I. MEDICINE.
A sudden attack (Ett.-Laubäzvo = assault), “I strike” (morbo sacer) of consciousness accompanied by a neurovegetative discharge, with or without convulsions; depending on the predominance of one or another symptom, the clinical picture may vary greatly, losing those features which, in common opinion, would characterize the epileptic attack.
The “grand mal” attack is classically known in its successive phases: the aura (sensory, sensory-motor, vascular, neurovegetative, etc.), a prodromal sign of the impending seizure; the tonic phase (trismus, biting of the tongue, clenched fists, upward rotation of the eyeballs with eyelids tightly closed, loss of consciousness with dangerous uncontrolled falling); the clonic phase (rapid, violent, generalized muscular convulsive jerks); neurovegetative disturbances (foaming at the mouth, stertorous breathing, hypertension, pupillary dilation, cyanosis, urinary and fecal incontinence); and the post-epileptic coma (shallow, irregular breathing, pallor), which passes into a more or less prolonged deep sleep. Upon awakening, the patient, though feeling intense malaise and suffering the traumatic consequences of the attack, remembers nothing of what occurred.
Apart from such episodes, there are manifestations with partial symptomatology, in which, however, the characteristic feature of the sudden loss of memory of the episode is always present. Thus, in petit mal or “epileptic absence” (exceptional alteration of consciousness, more or less severe and prolonged, without convulsions); in epileptic vertigo (sudden sensation of rotation of one’s own body with partial clouding of consciousness); in “epileptic syncope” (sudden collapse and fall to the ground unconscious); in Bratz’s “affective epilepsy” (sudden onset after violent emotion, contrariety, etc.); and in “epileptic equivalents” (various motor, sensory, sensory, psychic manifestations) which appear rapidly, followed by total or partial amnesia, during which the patient may commit immoral or even very serious criminal acts in a manner that appears coordinated and voluntary, of which he later loses all or most memory and which he would be absolutely incapable of performing in a normal state, given the characteristics of his personality. Of this nature is the sudden impulse to drink alcohol (dipsomania) in a person previously even temperate.
Epileptoidism is a permanent psychopathic state that may also occur in persons who are not truly epileptic, characterized by impulsiveness, emotional incontinence with a tendency to anger, violence, lack of scruples, weak, restless, fickle will, egoism, fanaticism, bigoted ostentation of religiosity, and a clinging character. In long-standing epileptics, forms resembling dementia often appear, with a global reduction of psychic assets, deviations of practical activity up to true positions (v.), characterized by the onset of exceptional states with hallucinations, impulsiveness, hostile perception of the external world, lasting a few weeks. A status epilepticus may develop with the successive repetition of grand mal attacks, accompanied by a severe confusional state and danger to life.
Numerous and conflicting are the opinions on the causes and mechanism of epilepsy: spastic circulatory disturbances of the brain, allergic crises, parental alcoholism or syphilis, neurotropic toxins acting on a predisposed nervous system, sequelae of cerebral trauma (Jacksonian epilepsy) or pre- or neo-natal encephalitis, disturbances of the water balance of the nerve cell, sclerosis of the “hippocampus”; modern electroencephalography has proposed new causal hypotheses and has made great strides in diagnosis, particularly of equivalent forms.
Of great importance is the differentiation of true epilepsy from hysterical attacks (v.). The treatment of epilepsy, as far as possible causal or merely symptomatic, is the exclusive competence of the physician.
From a moral standpoint, the suddenness, involuntariness, abnormality, and often the complete absence of consciousness in the epileptic patient limit or even abolish his legal and religious responsibility, even in the more latent forms of “equivalents,” which must always be considered in cases where a precise immoral or criminal act contrasts with the ethical character of the individual. The educator, faced with difficult, impulsive individuals with poorly educated affective and volitional life, capricious and fickle, obstinate in some of their attitudes, should consider the possibility of “epileptoidism” and avail himself of medical assistance.
Bratz: W. Penfield-T. C. Erickson, *Epilepsy and cerebral localization*, Illinois 1941; R. R. Grinker, *Neurology*, 1944; G. Maruzzi, *L’a. sperimentale*, Bologna 1948. Gianfranco Tedeschi - Giuseppe de Ninna
II. MORAL THEOLOGY.
From the frequency of delinquency among epileptics, some (Positive School) have been led to posit a general causal relationship between epilepsy and criminality. The criminal act would be the unfortunate result of an “absence” such that an “equation” between criminality and epilepsy could be made. In the former, convulsions are replaced by violent and irresistible impulses to commit the crime. Progressing in its concepts, the Positive School went so far as to affirm the “equivalence between moral insanity, epilepsy, and the born criminal.”
This hypothesis is far from being confirmed by experience, at least with the frequency necessary to draw ethical-legal conclusions, and the absolute relationship between epilepsy and criminality is today generally rejected.
Nevertheless, it cannot be denied that in epileptics there is a diminution and sometimes a complete absence of moral responsibility, insofar as the mental integrity of epileptics is more or less deeply compromised even in the “free” intervals; and in the most severe forms, psychic disintegration takes on the aspect of dementia. To be precise, moral imputability is completely lacking during the epileptic attack. To determine moral imputability of acts performed outside the attack, one must consider the dispositions of character, the state of the patient, and the periodicity of the attacks, which, if they recur very frequently, create a habitual condition of semi-insanity. In general terms, epileptics must be considered as having a diminished capacity to understand and to will. This diminution must be taken into account both in the administration of the Sacraments and in the evaluation of crimes and the imposition of penalties.
Given the alarming manifestations of the disease, at least during the state of crisis, epileptics cannot receive certain Sacraments because of the danger of irreverence.
Thus, during the epileptic attack, Holy Communion cannot be administered to them unless there is danger of death, provided that there was a previous will to receive it and that the danger of irreverence is removed (Roman Ritual, tit. IV, cap. 4, n. 4).
Moreover, given the impossibility or at least the great difficulty of curing the disease, those who have been or are epileptic are considered in the Code of Canon Law (can. 984, 3°) as irregular by defect (irregulares ex defectu) with regard to the Sacrament of Holy Orders.
The 1917 Code of Canon Law does not distinguish between pre-pubertal and post-pubertal epilepsy, and since the doctrine prior to the Code held, at least according to the prevailing opinion, that there is no irregularity in cases of epilepsy with pre-pubertal manifestations, provided there are no subsequent relapses ensuring moral certainty of complete recovery, theoretically this reasoning can still apply today, based on can. 6, §2, 4° (cf. F. M. Cappello, *De Ordine*, 2nd ed., Turin 1947, no. 483). In practice, however, physicians very rarely pronounce with certainty a complete and perfect recovery.
If epileptic manifestations occur after sacred ordination and there is moral certainty of the overcoming of the illness, the Ordinary may permit his subjects "to exercise the Orders received" (can. 984, §3).
Turning to canon law regarding penalties, since criminal responsibility does not arise from physical imputability unless through and by means of moral imputability, it is evident that where this is lacking, as during an epileptic seizure, the person is incapable of committing a delict (can. 2201 §1). Even outside of a seizure, it is necessary that the ecclesiastical judge, in imposing a penalty, take into account the mental state of the epileptic (can. 2218 §1-2).
Bratz: P. Gasparri, *De S. Ordinatione*, I, Paris-Lyons 1893, nos. 278-280; J. Antonelli, *Medicina pastoralis*, 5th ed., II, Rome 1934, nos. 208-209; G. Gaudier, *Les irregularités ex defectu*, Paris 1933; F. Roberti, *De delictis et poenis*, I, 1, Rome s.d., nos. 108-109; H. De Messaecolor, *De actibus humanis*, 5th ed., Milan 1939, pp. 104-106; B. Di Tullio, *Trattato di antropologia criminale*, Rome 1945, pp. 483-492; F. M. Cappello, *De Sacramentis*, I, 5th ed., Turin-Rome 1947, no. 406; A. Lanza, *Theologia moralis*, I, Turin-Rome 1949, no. 111, 3.