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A Possible Diagnosis For Archie

Dear Archieologists,

I am a medical student from Western Australia (W.A.) and I have been intrigued by the portrayal of Archie’s condition, since I am currently chugging through an otherwise tedious neuroscience unit. I am unwilling to detract from the excellent script and superb performance of the actor etc., so this diagnosis is based on observations alone and ignores any artistic license (in short, I don’t know whether the film makers had something else, if anything, in mind.)

I would also like to add that epileptics often face unnecessary discrimination, especially among peers in the workforce, even in these enlightened days of increased knowledge and anticonvulsant therapy (there are plenty of ‘Hunters’ around the place.) I hope that this diagnosis helps to inform people and increase awareness of the condition. The portrayal of a character who is able to succeed and gain the respect of his colleagues despite his epilepsy is wonderful. There is probably considerable artistic license used to bring about the ‘recovery,’ although it is in the realms of possibility. Today Archie would probably be successfully treated with anticonvulsants, which have only been widely available since the early twentieth century. It is most likely he would need to take the drugs continuously for the rest of his life. Interestingly, Archie would be disqualified from driving in W.A. for three months after a seizure and he would be permanently prohibited from serving in the Australian Defence Force or the W.A. Police Force, operating heavy machinery and driving a bus. In addition, Archie would have to (legally) try and conceal his condition from employers, even when applying for desk jobs, since many people are unaware of how successful anticonvulsants can be and epilepsy is often (falsely) equated with intellectual impairment or emotional instability.


History

The first (The Duel) and third (The Duchess and the Devil) seizures are seen or presumed to occur after the patient has just woken up, presumably from a nightmare. The second seizure (The Duel) occurs during the early hours of the morning when it can be assumed that the patient has missed sleep, perhaps due to the preparation and/or the presence of Simpson on board the Indefatigable.

The first seizure begins as a brief series of myoclonic jerks when the patient awakes from the nightmare. He is still conscious and the upper body is mostly affected. Then there is a sudden progression to a fairly typical tonic-clonic grand mal seizure: the patient loses consciousness, his muscles become tense and he falls to the ground in the initial tonic phase. The clonic phase begins when the patient is on the ground. There are generalised convulsions and the patient is extremely tired or unconscious afterwards (incontinence does not necessarily occur with this type of seizure.) The second seizure is a fairly typical myoclonic seizure. The third seizure is probably also a myoclonic seizure as the patient is reasonably alert immediately afterwards and again it is the upper body that is mostly affected.


Diagnosis

A possible diagnosis is Juvenile Myoclonic Epilepsy, or Janz Syndrome. Despite its name the disease may develop as late as 26 years of age, although it most commonly appears between 12 and 16 years of age. In the vast majority of patients the myclonic seizures are often but not always associated with grand mal seizures. Myoclonic epilepsy is often not picked up in children if they sleep alone, since attacks most commonly occur after the patient has just woken up. Sleep deprivation is also a common cause of myoclonic seizures in these patients but it may be mistaken for irritability or discomfort in a child trying to sleep. This disease is thought to be inherited on a non-sex chromosome (number six) and it appears as commonly in males as females. The actual trigger for the seizures is not known.

--Suze E.

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