EPILEPSY. - I. MEDICINE. - An accessional disorder (ἐν-λαμβάνο = "I assail," "I strike"; morbus sacer) of consciousness accompanied by a neurovegetative discharge, with or without convulsions; depending on the predominance of this or that symptom, the picture can vary greatly, losing those features that in common opinion would be the characteristic of the epileptic attack.
The crisis of "grand mal" is of classic recognition in the successive unfolding of the aura (sensory, sensorial, motor, vascular, neurovegetative, etc.), a prodromal warning sign of the onset of the seizure; of the tonic phase (contraction of the jaw, biting of the tongue, clenching of the fists, rotation of the eyeballs upward with eyelids tightly closed, loss of consciousness with a dangerous fall without control); of the clonic phase (rapid, violent, extensive muscular convulsive jerks); of the neurovegetative disturbances (foaming at the mouth, stertorous breathing, hypertension, pupillary dilation, cyanosis, loss of urine and feces); of the post-epileptic coma (shallow and irregular breathing, pallor) which continues into a more or less prolonged deep sleep, on awakening from which the patient, though with a sense of severe malaise and the traumatic consequences of the crisis, remembers nothing of what happened.
Apart from this episode, manifestations with partial symptomatology fall within the concept of epilepsy, in which, however, the characteristic note of suddenness and of the disappearance of all memory of what occurred is always present. Thus in petit mal or "epileptic absence" (accessional 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 swaying and falling to the ground unconscious); in Brata's "affective epilepsy" (sudden onset after a violent emotion, upset, etc.); in "epileptic equivalents" (various motor, sensitive, sensorial, psychic manifestations) that appear rapidly, followed by total and partial amnesia, during which the patient may commit immoral or criminal actions, even quite serious ones, and on a plane of apparent coordination and voluntariness of which he loses more or less completely the memory and of which he would be absolutely incapable, in a normal state, given the characteristics of his moral person; of this nature is the sudden impulse to drink alcohol (dipsomania) in a person previously even abstemious.
"Epileptoidism" is a permanent psychopathic state that can, however, also present itself in persons not truly epileptic, whose fundamental notes are: impetuosity, impulsiveness, emotional incontinence with a tendency to anger, to violence, to lack of scruples, weak, restless, fickle will, egoism, fanaticism, bigoted degeneration of religiosity, viscous character. In long-standing epileptics, forms of a demented type easily appear with a global reduction of the psychic patrimony, deviations of practical activity up to true psychoses (v.), characterized by the onset of states of excitement with hallucinations, impulsiveness, hostile apperception of the external world, lasting a few weeks. A status epilepticus can develop in the supervening repetition of "grand mal" attacks, with a severe confusional state and danger to life.
Numerous and discordant are the opinions on the causes and the mechanism of epilepsy; spastic circulatory disturbances of the brain, allergic crises, alcoholism or syphilis of the parents, neurotropic toxins acting on a tainted nervous system, sequelae of cerebral traumas (jacksonian epilepsy) or of pre-or neo-natal encephalitis, disturbances of the water metabolism of the nerve cell, sclerosis of the "horn of Ammon"; modern "electroencephalography" has proposed new causal hypotheses and has made great strides in diagnosis, particularly of the equivalent forms.
Of great importance is differentiating true epilepsy from the attack of hysteria (v.). The treatment of epilepsy, as far as possible causal or merely symptomatic, is fully within the competence of the physician.
From the moral side, the suddenness, the involuntariness, the abnormality, and often the complete absence of consciousness in the epileptic mark the limitations or indeed the abolition of his legal and religious responsibility, even in the most masked forms of "equivalents," which one must always consider in all those cases in which an unthought-of immoral and criminal action contrasts with the ethical figure of the individual. The educator, in the presence of "difficult" individuals, impulsive, with an affective and volitional life that is poorly educable, capricious and fickle, stubborn in certain of their attitudes, must consider the possibility of "epileptoidism" and avail himself of the physician's work.
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II. MORAL THEOLOGY
From the frequency of delinquency among epileptics, some (the Positive School) have been led to find a general relation of cause and effect between epilepsy and delinquency. The criminal act would be the disastrous result of an epileptic "absence," so that one could form an equation: criminality = epilepsy. In the former, the convulsions are replaced by violent and irresistible impulses to commit the crime. Progressing in its concepts, the Positive School came to affirm the equivalence between the moral lunatic, the epileptic, and the born criminal.
The hypothesis is far from being confirmed by experience, at least with the frequency necessary to draw ethico-juridical consequences from it, and the absolute relation between epilepsy and criminality is today commonly rejected.
Nevertheless, a diminution and at times an absolute absence of moral responsibility cannot be denied in epileptics, inasmuch as the mental integrity of epileptics is more or less profoundly compromised even in the "free" intervals themselves; and in the graver forms the psychic disintegration assumes the appearance of dementia. To be precise, moral imputability is completely lacking during the epileptic seizure. For the determination of the moral imputability of acts performed outside the seizure, one must take into account both the dispositions of the character, and the state of the sick person, and the periodicity of the seizures, which, if they recur very frequently, create a habitual situation of semi-mental infirmity. As a general rule, epileptics are to be considered under a general aspect of diminished capacity to understand and to will. And this diminution must be taken into account both in the administration of the Sacraments and in the evaluation of the crime and the imposition of penalties.
Given the impressive manifestations of the disease, at least during the state of seizure, epileptics cannot receive certain Sacraments because of the danger of irreverence.
Thus during the epileptic seizure Holy Communion cannot be administered to them, unless there is danger of death, it is established that they had a previous will to receive it, and the danger of irreverence is removed (Rituale Rom., tit. IV, cap. 4, n. 4).
Furthermore, given the impossibility, or at least the great difficulty, of removing the disease, those who were or are epileptics are considered in the CIC (can. 684, 3°) as irregular by defect (irregulares "ex defectu") in relation to the sacrament of Holy Orders.
The CIC does not distinguish between pre-puberal and post-puberal epilepsy, and since the doctrine prior to the CIC held, at least according to the prevailing opinion, that there was no irregularity in the case of epilepsy with pre-puberal manifestations, without relapse afterward, so that there was moral certainty of absolute recovery, speculatively it may be held even today to be the same, on the basis of can. 6, 2°, 4°. (cf. F. M. Cappello, De Ordine, 2nd ed., Turin 1947, n. 483). But in practice physicians very rarely pronounce for a complete and perfect recovery.
If, moreover, the manifestations of epilepsy occur after sacred Ordination, or there is moral certainty of the overcoming of the disease, the Ordinary can permit his subjects the exercise of the Orders received (can. 684, 3°).
Passing to canonical penal law, since penal responsibility does not arise from physical imputability except through and by the interposition of moral imputability, it is evident that where this is lacking, as during the epileptic seizure, there is incapacity for crime (can. 220: § 1). And even outside the seizure, it is necessary that the ecclesiastical judge, in imposing the penalty, keep in mind the mental state of the epileptic (can. 2218 §§ 1-2).