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.

The fact that recovery is rare should not be hidden from patients and
friends. Perhaps 8 per cent of all classes recover--and "recovery" may only
be a long interval--but 4 per cent of these are Jacksonian, syphilitic or
accident cases. Only one victim in every thirty recovers from true
epilepsy; and these are very mild cases, in which the fits are infrequent,
there is no mental impairment, and bromides are well borne. The earlier the
onset, the more severe and frequent the attacks, the deeper the coma, and
the worse the mental decay, the poorer the outlook.

_Cure is exceptional_, but by vigorous treatment the severity of the malady
may be much abated. _Petit mal_ is no more hopeful than _grand mal_; less
so in cases with severe giddiness; in all cases, the better the physical
condition and digestive powers of the patient, the brighter the outlook.