Paralysis of the cardiac or respiratory centre is usually the immediate cause. Mechanical asphyxia is not infrequent.
No reputable life-insurance company will accept an applicant known to be af fected with epilepsy.
What constitutes a cure in epilepsy? Freedom from attacks for one, two, five, or even ten years cannot be considered as final evidence of cure, since it has been the personal experience of every neurolo gist to note recurrences after such inter vals of remission. I myself have known a patient to exhibit a spontaneous remis sion for twenty-three years, the attack recurring without determinable new cause, and in exactly the same form, clinically, as at first. G. M. Hammond takes the position that relief from at tacks for one or two years constitutes a cure, subsequent recurrences to be con sidered as new attacks. The objection to this teaching—there are many—is that, in some patients in whom the dis ease lasts through life, the attacks may be reported by intervals of a year or longer throughout the disease. Person ally, I do not believe in the radical cure of epilepsy, if the disease has persisted for more than two years, except, perhaps, under an ideal environment attainable only in specially equipped institutions.
Of importance in estimating the prog nosis is the presence or absence of stig mata of degeneration. Epileptics ex hibiting cranial asymmetry or anomalies of development or well-marked intellect ual or moral perversions are notoriously patients admitting only the most simistic prognosis. Well-marked perio dicity in the occurrence of attacks in a subject constitutes a factor somewhat favorably modifying the prognosis.
A cautious prognosis should be made in any ease of epilepsy in which the sleep-stage is habitually omitted. and in which the patient is constant iy afflicted with severe frontal headache. L. Pierce Clark (N. Y. Med. Jour., June 19, '97).
Medical Treatment.—The ideal treat ment of idiopathic epilepsy is, in my opinion, attainable practically only through institution environment, organ ized on the colony-plan, or as it is in Ohio or at Sonyea, New York. The necessary regulation of the habits, diet, clothing, exercise, sleep, and the ployment of various adjuncts, direct and indirect, such as hydrotherapy and gymnastics, and appropriate culture of the mind and morals, can be accom plished systematically only in an insti tution established and conducted for such a purpose.
The experience of the epileptic colony at Chalfont, St. Peters, Bucks, during the four years of its existence, pointed to the fact that the younger the epileptic and the sooner he was admitted after the onset of the seizures, the more sat isfactory the result of the general man agement and nr'ginie adopted. The prin ciples directing the management are simple: (a) removal of the epileptic from town to country; (b) regular em ployment under direction; (c) the main tenance of a well-ordered and regular mode of life, with avoidance of excite ment and abstinence from alcoholic liquors; (d) abundance of good nour ishment of a simple nature. The general result was that the fits in the majority of cases diminished both in number and severity. in some cases to quite an ex traordinary extent; the physical health materially improved, while the condition in all but a few cases showed obvious improvement. Aldren Turner (Brit. Med. Jour., Apr. 23, '9S).
The early treatment of reflex epileptic phenomena is of great importance. Many eases of nocturnal epilepsy pass unrecognized until far advanced. Out of 485 persons admitted to the Craig Colony, S3 per cent. had developed the disease before the age of 20 years, and 20 out of a series of 145 had given mani festations of the disease as early as the sixth month of life. Before making a prognosis or instituting treatment it is well most carefully to consider the an cestry. Drugs, the chief object of which is to suppress the convulsive phenomena, should not be given young subjects, for such treatment not only is liable to mask the disease, but experience has shown that it will seriously impair the digestive and assimilative functions. It is wrong to operate upon an epileptic brain after an injury and years of convulsive seiz ures. A study of the aura, which is the "sign-post" to the treatment, is impor tant. The colony plan allows of the entire and much-needed control of all the habits of life of the individual. W. P. Spratling (Med. Record, Oct. 28, '99).