The Treatment of Epilepsy
BISHOP MCMILLEN, M. D., SHEPARD, O.
Most epileptic patients are chronic medicine takers. They like medicine. They expect results. But most physicians have lost faith in finding a drug that will cure, so they fall back on potassium bromide in some combination, and often one physician after another gives the patient bromides. The patient learns to buy it by the ounce and takes it in repeated doses day after day.
I seldom see a simple case of epilepsy. They are usually complicated with bromine poisoning. Many patients take from 80 to 100 grains of potassium bromide a day for months. Some of our larger institutions where these patients find a home use such routine treatment. As a result their bodies become saturated with the drug.
The mental degeneration which is noticed in epileptics is caused by the abuse of the use of potassium bromide, as much, if net more, than to the secondary motor degenerations which follow after years of motor convulsions.
More than twenty years ago I called attention to the distorted fingers and toes seen in chronic epileptics, due to secondary degeneration, as a symptom in prognosis. When this symptom is present we should not hold out a promise of recovery. But if there is no degeneration and no distortion of the fingers, the chances of a recovery are much more favorable. I have never seen a case that recovered after the fingers became distorted, and there are but few chronic cases that do not have this symptom.
I believe a constant use of the bromides in large doses contributes its share to increase the secondary degenerations with their attendant mental enfeeblements.
The sympathetic nervous system controls all the involuntary functions. Epilepsy in its early stages would seem to be entirely a disease of the sympathetic nervous system and caused by an irritation of some function which it controls. The brain symptoms are secondary. The bromides are given to relieve these secondary symptoms. The digestive tract is usually disarranged where the primary symptoms originate. So it must be to relieve these primary causes that treatment should be directed. Potassium bromide disturbs digestion and nutrition. But the bromides are a necessary evil when the attacks are severe.
I usually give the bromide of potassium in 20-grain doses four times a day for eight days. Then I stop it. If the attacks become severe in two or three weeks I go back to this bromide again. But keep the intervals between the giving of the bromide as far apart as the patient's condition will admit. But it must be used to reduce the severity of the attack. Nothing else seems to do so well. It is the abuse of its use that should be avoided. And eight days seems to be long enough to give it to modify the attacks. Then allow it to get out of the brain cells by elimination.
Gelsemium, passiflora and valerian, either may be combined with the potassium bromide according to their specific indications.
Hydrastis is one of our best remedies to relieve irritation of the sympathetic, through its effects on the mucous membranes. Saw palmetto, leptandra, collinsonia, and many other remedies that influence the mucous membrane or an organ which is supplied with mucous membrane should benefit epilepsy. Cures are made by remedies that remove causes, not by these that simply suppress the attacks.
(An advanced step has been recently taken in the study of this serious disease, by a writer in The Medical Record who says that in its treatment the profession is yet groping in the dark. This is especially true of idiopathic epilepsy. He makes, however, the following important statement: "There exist certain epilepsies which occur from reflex causes. These are amenable to treatment, especially in the early stages of the disease. He says that failure to search for the cause in these cases, constitutes almost criminal negligence."
This writer's ideas correspond with ours to an extent. He says we can no longer say, "this patient has epilepsy, therefore give him a bromide." Many have abandoned the bromides, except in certain few cases where they are needed as palliatives. The writer quotes good authorities, who claim that 25 per cent of these cases can be cured. All of our writers claim that each patient must be studied individually and treated with reference to the conditions there existing. The above mentioned writer makes the following suggestions as to diet.
"Have the meals regularly, with the last meal of the day early and light. Do not eat until there is a sense of fullness. Do not eat peas, beans, veal, much meat or cereals. A vegetable diet is the best. Fish and milk are permissible. Use as little salt in the food as possible and forego tea and coffee. Do not eat much at one setting. Keep the bowels free and the intestinal tract aseptic by the use of some antifermentative. Flush the colon frequently. Take warm salt baths, not remaining in the water sufficiently long to fatigue.
Sleep with the head high, and keep the feet warm at all times and especially at night. See that any defects in the eyes are corrected and do not use the eyes for a long time without resting. If glasses are worn, have the frames straightened at regular intervals. Take as much outdoor exercise as possible without fatiguing. Spinal douches and massage should be taken regularly. If seizures come early in the morning take 15 grains of the bromide of sodium before retiring."—ED.)
Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.