Having noted in numerous epileptic cases deficient absorption and elimina tion of calcium, the writers administered various preparations of that drug by mouth and hypodermically in fourteen epileptic cases. A decrease in the num ber of seizures followed in nearly all the patients treated, diminution or increase in the frequency of the attacks corre sponding to increased or diminished ab sorption of the calcium. In a few cases which were uninfluenced by the treat ment it was ascertained that the entire amount of calcium administered had been eliminated in the farces. E. Antic uino and A. Bonelli (Riforma Medica, Sept. 5, 1902).
In giving the bromides certain general facts should be recognized. The potas sium salt is the most effective.
All bromide salts should be specially investigated as to purity of manufacture. Every dose of bromide should be given well diluted. The dose is inconstant necessarily and varies with the type and intensity of the disease in each patient. In an ordinary case, with attacks of moderate severity occurring four or five times a month, or less often, the patient should begin with 20-grain doses twice daily. This may be increased or dimin ished according to the effect. An in sufficient dosage is practically useless; on the other hand, no unnecessary excess of the drug should be continuously duced into the system, since bromism, if prolonged, induces a condition scarcely less deplorable than epilepsy.
In both symptomatic and idiopathic epilepsy the systematic use of bromides is practically the only treatment. A cure can be obtained only in an exceed ingly small number of cases. The ex istence of organic heart or brain disease increases the susceptibility to the drug. It should be given largely diluted, and it should also be administered with refer ence to the time when the seizures most commonly occur, and the dose increased before any unusual strain, or in young patients at the approach of puberty. After the patient has been three years without any manifestation of the disease, it is safe to begin to diminish the dose.
Epilepsy is the only disease in the treatment of which we are justified in deliberately producing a degree of bro mism. Seguin (N. Y. Med. Jour., Mar. 29; Apr. 5, 26; May 31, '90).
Strontium bromide is far less apt to produce acne, mental depression, and gastric disturbance than the correspond ing salts of potassium. Antipyrine, in doses of 10 or 15 grains a day, can be given with aumionium or strontium bromide for several months without ill effects. Editorial (University Med. Mag., May, '97).
Sulphonal and trional will prove use ful in a considerable number of the epi leptic cases as adjuncts to the bromides, nated. Frost (State Hop. Bull., Oct.,
'97).
The addition of compound syrup of the hypophosphites to the bromide of so dium and ammonium of distinct value in averting or diminishing dullness, muscu lar depression, and feebleness of circula tion. Lloyd Andriezen (Lancet, Aug. 26, '99).
The bromides of ammonium and stron tium are less depressing than the bro mide of potassium. When large doses are given, strychnine should be coupled with the bromides to counteract the de pressing effects of the latter. The writer favors a diet from which meat and eggs are excluded for a time. Fletcher Beach (Lancet, Aug. 26, '99).
Of the various bromides the prepara tion with strontium is far more effectual in the treatment of epilepsy than is that with potassium, sodium, or ammonium. Its sedative action is well marked; it causes but slight, if any, disturbance of the gastric functions, and it seems to act as a general nervous tonic. It neither impairs the mind of the patient nor pro duces aneemia, but, on the other hand, seems to benefit the circulation. One drachm four times a day to an adult, and proportionate doses to children, are recommended. Cullinan (Lancet, Oct. 7, '99).
By diminishing the amount of salt in the food of epileptics the therapeutic ac tion of the bromides is in a large meas ure increased. The bromide of sodium seems to be the least toxic and to ap proach more closely in nature the sodium chloride which it should replace. Edw. Toulouse (Gaz. des HOpitaux, July 21, 1900).
A combination of diet, regular occupa tion, and personal hygiene with the bro mides gives the best results in treating idiopathic epilepsy; the bromides, singly or combined, still remain the chief seda tives for the epileptic state: in the young epileptic, to secure a possible en tire suppression of attacks and ultimate cure of the disease; in the adult, an amelioration of frequent paroxysms and comparative physical and mental com fort. The bromides to be effective in given in large daily doses to suppress convulsions: from 300 to 500 grains, if necessary. They should be given gradu ally to find the sedative level, at which level it is the physican's principal duty to maintain them. Hot and cold baths, high enemas, alimentary antisepsis, and massage are absolutely essential to suc cessful bromide medication. Bromine is a worthy substitute for the bromides in many eases in which the latter are contra-indicated and cannot be given in high dosage. Salt-starvation or semi salt-starvation is a great adjuvant to the bromide treatment, and should be thoroughly tried in all cases in which bromides or bromine are apparently con tra-indicated before they are discarded. L. P. Clark (Med. Record, Jan. 12, 1901).