If the attacks occur at more or less regular intervals, as at the menstrual epoch in women, such periods of attack should be anticipated by temporarily increased doses. Gowers's plan is quite effective in some cases, though bordering on the heroic. He gives one full dose of potassium bromide in the morning after breakfast in half a pint of water, begin ning with 2 drachms every second morn ing, increased to 3 drachms every third morning, and 4 or more drachms (an ounce sometimes) every fifth day. The dose and order of interval are then re versed and the treatment is continued in this way for six weeks; small doses are then given for a year or more.
Potassium bromide seems to be curi ously limited in its power for good in the treatment of epilepsy. Occasionally after having been effective for weeks or months or even years, its effectivenss will, without assignable cause, cease. This is true not only of potassium bro mide, but of nearly, if not every, other drug useful in epilepsy. Some other salt of bromide or several of them in com bination (sodium, strontium, ammonium, lithium, are valuable in the order men tioned) or one or two of the bromides in solution with antipyrine or in combina tion with phenacetin may be advantage ously substituted for the single salt.
Of S cases of epilepsy treated for a period of six weeks by Bechterew treat ment, in 4 cases there was complete sus pension of the fits, in 3 other cases the fits were replaced by infrequent attacks of vertigo, and in the last case there were four attacks of vertigo and two convulsions. The results were due to the combination of drugs and not to the bromide alone. De Cesare (Rif. Med., Aug. 13, '97).
Adonis vernalis may have some influ ence in attenuating the attacks, but it may cause them to occur more fre quently. It has no advantage over bro mide. G. Gianni (La Riforma M6d., Feb. 15 to Mar. 1, 1900).
Sometimes the addition of one of the motor depressants—as hyoscyamus, co nium, belladonna, or their alkaloids—is quite as effective, at least temporarily. As a matter of further curious interest it has been proved by experience that in such cases a change to almost any new drug will result in temporary improve ment: a fact which explains, in part at least, the almost limitless pharmacopoeia of the disease.
Withdrawal of the bromides in cases of epilepsy long under bromide treat ment is generally followed by improve ment of the patient. At times this gain is startling. F. Peterson (N. Y. Med.
Jour., No. 914, p. 73S, '96).
The use of opium reintroduced re cently by Flechsig is deserving of men tion and a limited commendation. Flechsig's method consists in the daily administration of opium in the form of the solid extract in doses gradually in creased up to several grains (12 to 15) daily, five or six weeks usually being re quired. Treatment by bromide is then substituted for the opium. This treat ment is of distinct benefit in old long standing idiopathic epilepsies which have not been benefited by the bromides. It is contra-indicated in recent epilepsies and in the organic cases.
The Flechsig method of treatment is of but little value in chronic cases of epilepsy in which dementia has taken place to any marked extent. Clark (Amer. Medico-Surg. Bull., July 23, The best treatment of epilepsy is to put the system in such a condition that excitants to epileptic attacks, such as autointoxications from the gastro intestinal tract, from fatigue. from poi sonous products, which should be elim inated from the body, will not develop within the body, and also to guard against those experiences which we have learned often precipitate attacks. Also so to influence neuromotor irritability in a sedative way that discharge of energy in the shape of explosion will be less likely to occur. As to neurasthenia, the writer finds that its treatment by rest, exercise, change of environment, isolation. hydriatics. massage, diet, avoidance of deleterious indulgences, and conformation to hygienic rules is so far superior to drug-therapy that lie rarely uses drugs in these eases, unless to fulfill some pointed indication. Joseph Collins (Medical News, July 5, 1902).
Four remedies are deserving of special mention in connection with special forms of epilepsy for the relief of which they seem especially efficacious: nitrite of amyl and monobromated camphor in cases of petit mal, duboisine in hystero epilepsy, and the hydrobromate of co niine in the status epilepticus. Nitrite of amyl also possesses value as a drug which, if used promptly in cases pre ceded by an aura, will often prevent the further development of the attack. Chloroform by inhalations is at times temporarily useful in controlling the status epilepticus. I have found the use of cardiac tonics of positive value in com bination with the bromides in what is known as cardiac epilepsy. The condi tion of the heart and pulse is the guide to the selection of the adjuvant drug.