The facial expression of most epileptics indicates abnormal mentality.  When the seizures have been so frequent and severe as to cause mental decay, the actions are awkward, and the gait slouching and irregular.  Progressive poor memory is one of the first signs of intellectual damage consequent upon severe epilepsy.

Though the disease may occur at any age, most cases occur before the age of twenty, there being good reason to look for other causes (often syphilis) in cases which occur after that age.  Of 1,450 of Gowers’ cases, 30 per cent commenced before the age of ten; 75 per cent before twenty.  In Starr’s 2,000 cases, 68 per cent commenced before the patient was twenty-one.

According to Turner, the first epoch is from birth to the age of six, during which 25 per cent of all cases commence, usually associated with mental backwardness, and some due to organic brain trouble.  The second epoch is ten to twenty-two, the time of puberty and adolescence, during which time no less than 54 per cent of all cases commence.  This is, par excellence, the age of onset of genuine epilepsy, the mean age of maximum onset being fourteen in men and sixteen in women.  The remaining 21 per cent of cases occur after the age of twenty-two.

In 430 cases of epilepsy in children, Osler found that 230 were attacked before they reached the age of five, 100 between five and ten, and 100 between ten and fifteen.

Epilepsy, then, is a disease of early youth, coming on when the development and growth of the nervous and reproductive systems is taking place.  During this period, causes, insignificant for stable people, may light up the disease in those of unstable, nervous constitution, a fact which explains the importance of training the child.

Both sexes are attacked.  If we consider only cases of true idiopathic epilepsy female patients are probably in excess, but in epilepsy in adults, from all causes, males predominate.  In females, the menopause may arrest the disease.

In days gone by, epilepsy more rarely commenced after the age of twenty, but in these days of nerve stress it commences more frequently than formerly in people of mature age.  A victim who has a fit for the first time after the age of twenty, however, should consult a nerve specialist immediately.

In its early stages there are no changes of the brain due to, or the cause of, epilepsy, but in long-standing, severe cases, well-marked, morbid changes may be found.  These are the effects, not the cause, of the disease, and they vary in intensity according to the manner of death and the length and severity of the malady.  They probably cause the mental decay and slouching gait mentioned before.

Fits may suddenly cease for a long time, but they usually recur, and most patients have them more or less regularly through life.