To a certain extent, though far more limited than one would suppose from a priori reasoning, the etiology affords a basis for treatment. Antisyphilitic treatment should be at least given an energetic trial, as epilepsy is due pri marily to syphilis. Such patients, how ever, as a matter of fact, are not often cured by this means, and, as a further fact of interest, it will be found that such patients do not bear well energetic spe cific treatment. Various toxic agencies or conditions of visceral disease, standing in a presumably causative relationship, should be treated, of course, but cure of the toxwmia or the visceral disease very rarely results in cure of the epilepsy.
Removal of sodium chloride from the diet and replacing it by a bromine salt tried successfully in 2S cases. Even the bread was prepared by baking it with bromide of sodium instead of table-salt. No symptoms of bromism appeared. Conclusion that in every ease of epi lepsy a diet deprived of sodium chloride is applicable and should be tried. The treatment is most successfully carried out in an institution. It is based upon the view advanced by Richet and Tou louse that the body is more susceptible to bromine when the chlorine has been reduced. The introduction of bromides into the nutriment and especially into the bread as a substitute for the so dium chloride is an agreeable way of administering the drug. R. Balint (Ber liner klin. Woch., June 10, 1901).
A rise of temperature follows about 45 per cent. of all attacks, the tempera ture going highest, as a rule, after grand-mal seizures, in which muscular contractions are greatest; but also sometimes reaching 102° F. or over, in petit-mel and psychical attacks. prob ably indicating in the latter case the disturbance of the thermal centres in the brain.
Treatment demands that the epileptic and his disease be considered as a unit and treated as such. As antispasmodics, camphor, opium and its derivatives, valerian, and belladonna are valuable. The opium-bromide treatment of Flech sig is valuable in some cases. In a case of status epilepticus the best formula for stopping the attacks is the follow ing:— Potassium bromide, 2 ounces. Chloral hydrate, 5 drachms. Morphine sulphate. 2 grains. Deodorated tincture of opium, 60 Inlmms.
M. Add enough water to make six teen ounces, and give the patient one ounce after he has had six attacks in rapid succession. Repeat in two hours
if not effective. William P. Spratling (Jour. Amer. Med. Assoc., May 3, 1902).
Surgical Treatment.—The surgical treatment of epilepsy is limited to those cases recognizable positively as depend ent upon an organic lesion of limited extent and surgically accessible, the loca tion of the explosive focus being deter minable at least approximately from the symptoms.
1. Surgical interference is advisable in those cases of partial epilepsy in which not more than one, or at the utmost two, years have elapsed since the traumatic injury or the beginning of the disease which has given rise to the convulsive seizures.
2. In cases of depression or other in jury of the skull, surgical interference is warranted, even though a number of years have elapsed; but the prospect of recovery is brighter the shorter the period of time since the injury.
3. Simple trephining may prove suf ficient in a number of cases, and par ticularly in those in which there is an injury to the skull or in which a cystic condition is the main cause of the epi lepsy.
4. Excision of cortical tissue is advis able if the epilepsy has lasted but a short time and if the symptoms point to a strictly circumscribed focus of disease.
5. Since such cortical lesions are often of a microscopical character, excision should be practiced, even if the tissue appear to be perfectly normal at the time of operation; but the greatest caution should be exercised in order to make sure that the proper area is re moved.
6. Surgical interference for the cure of epilepsy associated with infantile cerebral palsies may be attempted, par ticularly if too long an interval has not elapsed since the beginning of the palsy.
7. In cases of epilepsy of long' stand ing, in which there is in all probability a wide-spread degeneration of the as sociation-fibres, every surgical procedure is useless. Sachs and Gerster (Amer. Jour. Med. Sci., Oct., '96).
As in many cases of traumatic Jack sonian epilepsy, cure may be effected by removal of the injured portion of the skull or of degenerated and adherent meningeal structure; extirpation of the affected motor centre is not indicated until after failure of this operation. Braun (Centralb. f. Chin, No. 44, '97).