Morphologische Aspekte Der Epilepsien: Pathogenetische, Pathologisch-Anatomische Und Klinische Probleme Der Epilepsien
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Soweit wir die Geschichte der Medizin zuriickverfolgen, begegnen wir in den Krankheitsschilderungen dem groBen epileptischen Anfall, dem grand mal, dem morbus sacer. Erst im vergangenen Jahrhundert begann aber eine Differen- zierung der Krankheit Epilepsie, indem man dem grand mal eine Reihe anderer anfallsartig auftretender Krankheitszeichen an die Seite stellte und den Verlauf der Krankheit bei den verschiedenen Anfallsformen zu beriicksichtigen lernte. Die Erforschung der Krankheit muBte dabei im 19. Jahrhundert noch vorwiegend von der klinischen Beobachtung ausgehen. Die Erfolge dieser Bemiihungen waren bewundernswert. Sie sind u. a. an die Namen FALRET, DELASIAUVE, HERPIN, GOWERS, JACKSON, SAMT und REDLICH gekniipft. Die Kunst der arztlichen Be- obachtung und Beschreibung ist seitdem ohne Zweifel unter dem Eindruck tech- nischer Hilfsmittel seltener geworden. Damit geriet auch manche klinische Diffe- renzierung zu Unrecht in Vergessenheit. So fand, was heute als "psychomotorische" Epilepsie neu benannt wird, schon bei diesen Klassikern seine Beschreibung und eine Gliederung, die an Genauigkeit der klinischen Differenzierung die unsrige iibertrifft (z. B. FALRET, HERPIN und SAMT). Die pathologische Anatomie be- schrankte sich dagegen damals noch auf die Feststellung ziemlich grober Hirn- veranderungen. Es war in erster Linie dem kritischen klinischenAuge zu verdanken, wenn JACKSON urn 1875 ein Gebaude der Epilepsie errichten konnte, dessen Mauern noch heute alle inzwischen erreichten Kenntnisse der Morphologie und Physiologie in sich aufzunehmen vermogen, ja dessen GrundriB bis heute nicht iibertroffen wurde. Urn die Jahrhundertwende begann mit der Entwicklung der histologischen Methoden der Aufschwung dermorphologischen Epilepsieforschung.
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