The convulsive attacks are of the Jacksonian type, beginning in one particular group of muscles and spreading to neighbouring groups till all the muscles of the body may be affected. The convulsions may begin soon after the injury, for example, when the cause is a fragment of bone irritating the cortex; in other cases it may be several years before they make their appearance. The onset is usually sudden, and the "signal symptom"--for example, jerking of the thumb, conjugate deviation of the eyes, or motor aphasia--indicates the seat of the lesion. At first the attacks only recur at intervals of, it may be weeks or months, but as time goes on they become more and more frequent, until there may be as many as forty or fifty in a day. Sometimes the patient loses consciousness during the fit; sometimes he remains partly conscious. In course of time the same degenerative changes as occur in other forms of epilepsy ensue: certain groups of muscles may become paralysed; the patient may pass into a state of idiocy, or into what is known as the "status epilepticus," in which the fits succeed one another without remission, the breathing becomes stertorous, the temperature rising, the pulse becoming very rapid; finally coma supervenes, and the patient dies. _Treatment._--The administration of bromides is only palliative. Operation is indicated only when the "signal symptom" indicates a limited and accessible portion of the brain as the seat of the lesion, or when there is a depression of the skull or other definite evidence of cranial injury. The more recent the injury the better is the prospect, as secondary changes are less likely to have taken place, and the peculiarly irritable state of the brain--sometimes referred to as the "epileptic habit"--has not developed. The operation consists in opening the skull freely, and removing any discoverable cause of irritation--depressed bone, thickened and adherent membranes, a cyst, or sclerosed patch of cortex; it may be necessary to interpose a layer of tissue, a flap of fascia lata, for example, between the bone and the cortex of the brain. The point at which the skull is opened is determined by the seat of the injury and the focal brain symptoms. The return of fits within a few days of the operation does not necessarily mean failure, as they often pass off again. Complete and permanent cure is not common, but the number and severity of the attacks are usually so far diminished that life is rendered bearable.