This section is from the book "Materia Medica And Therapeutics Inorganic Substances", by Charles D. F. Phillips. Also available from Amazon: Materia medica and therapeutics.
Unless we are wholly to reject past records and the opinion of distinguished physicians, the nitrate has given good results in a large number of epileptic cases. Heim considered it the best of remedies, and Trousseau, who used also the chloride, places the silver salts second only to belladonna ("Traite," Ed., 1868). We need not, however, quote many authorities to the same effect: we recognize that it has relieved, sometimes even seemed to cure, cases of this disease, and may, therefore, under certain conditions, relieve others. We should not, with Krahmer, consider it most suited for the robust, with symptoms of head congestion, but rather for the delicate with morbidly irritable and susceptible nerve-system, and a languid state of the organic functions (Stille); it is in the pallid and anaemic that strychnia acts well sometimes (Tyrrell), and it is in similar cases that I should be hopeful of good results from silver. Curci considers that it does good in epilepsy connected with spinal disease, but when dependent on local lesion - as hemorrhage, softening, or tumor - the malady is not influenced by it. More definite indications we cannot at present lay down, and must acknowledge that, of any given number of cases, the majority at least will not yield to this remedy, and others, if they receive temporary benefit in the prolonging of the interval or lessened severity of the attacks, will ultimately relapse.
The greatest objection to nitrate of silver, and one which has led to its comparative disuse, is the possibility of its discoloring the patient, and this even without curing his malady - I have seen epileptics discolored by the medicine, and yet suffering as severely as ever from their convulsions. Unfortunately the nature of the disease requires a long continuance of treatment, and therefore a medicine must be preferred which shall, at least, not inflict so visible an injury, and we need seldom prescribe the silver salt until a fair trial has been made of bromides, of belladonna, etc. If, however, it be decided upon, then a purgative should be given at the commencement of, and occasionally during treatment; the remedy should be omitted for a few days at intervals, and the gums should be carefully watched for signs of systemic saturation. The use of nitrate for epilepsy in children has been objected to by Loebenstein, but I have seen it of service in chronic cases. Brenner recommends the chloride in infantile convulsions, and also in the brain-affections of typhus. Niemann found advantage from the ammonio-chloride in epilepsy and melancholia.
Dr. Ramskill has recorded two cases of epilepsy preceded by a "gastric aura" - i.e., "a sense of faintness, and of something turning upside down at the epigastrium" - which were benefited by the oxalate of cerium, when belladonna and bromides had failed to relieve. Cases of epilepsy without this aura were not benefited, and Dr. Ramskill suggests that in the gastric cases there was a primary failure of action in the splanchnic nerves, that the medicine acted as a sedative and conservator of their power, and that this influence being conveyed to the medulla lessened its excitability (Medical Times, i., 1862). The cerium salt has at least this advantage over nitrate of silver, that it will not darken the skin.
It is probable that of the older cases called epilepsy, and reported as cured by copper, a large proportion were hysterical, but Voisin reports from the practice of Herpin (Geneva) several illustrations of its power to cure chronic and obstinate cases of true epilepsy. He generally used the ammonio-sulphate alone, or alternately with zinc, for many months; the cure continued permanent some years afterward (Bulletin de Therapeutique, i., 1870). Halford made great use of copper combined with quinine in this malady (Medical Times, i., 1858), but general experience is not in its favor. Charcot has published a case carefully treated for three months with full doses of the ammonio-sulphate, but the convulsive attacks were rather increased during its use (British Medical Journal, i., 1875). I have given the sulphate and the acetate in varying doses and for long periods in many cases, but have not seen benefit from them in true epilepsy, although for epileptiform attacks dependent upon intestinal worms, they have several times proved useful.
Ferruginous medicines were at one time esteemed in the treatment of epilepsy or of attacks resembling it, but as diagnosis became more exact, and as more reliable remedies were discovered, iron passed out of use. Brown-Sequard taught that although it might improve the blood-condition, it tended to aggravate the malady itself; and H. Jackson, after much observation, expressed the same opinion. Dr. Gowers, writing more recently, acknowledges that it is sometimes the case, but, on the other hand, he has found that iron has a true place in the therapeusis of epilepsy: he has observed benefit from it in cases that are on the borderland between epilepsy and hysteria, and in others when the attacks were limited to the night-time, and in many of these cases the improvement was fairly permanent: he suggests, and I should think very plausibly, that it acts, like other metals (as silver or zinc seems to do in such cases), as a nerve-tonic, rather than simply by haematinic properties (Practitioner, October, 1877). Fabre has published a thesis showing the value of the medicine ("Fer contre l'Epilepsie," Paris, 1853). On the whole, we may conclude that iron has been unduly discredited in epileptic or epileptiform conditions. I think that when it arises from onanism, or when a patient is anaemic, it should be used, but generally in combination with bromides.
In true epilepsy, bromide of lithia was used by M. Levy and by Dr. Weir Mitchell. The latter physician found that it was determined to the skin much like other bromides, but it proved a better hypnotic, and in moderate doses of 10 to 20 gr., relieved or cured epilepsy after larger doses of other bromides had lost their effect (American Quarterly Journal, October, 1870).
The value of zinc salts in disorders of the nervous system has been much disputed, some physicians, as M. Herpin, recording extraordinary results from them, and others, as M. Gubler, denying to them any power.
There can be little doubt that the high estimate formed by M. Herpin of the efficacy of the oxide, and later of the lactate of zinc, in epilepsy, is unfounded - no other observer has verified his results - at the same time we cannot deny altogether their efficacy in some cases. Dr. Wilks has seen benefit from the oxide (Medical Times, i., 1869, p. 84), and Dr. Sieveking records successful results, though he does not value it highly. Dr. Russell Reynolds has known it serviceable, and Dr. Radcliffe, noting its effect in causing anaemia, suggests that it might best be tried in markedly congestive cases (Lancet, i., 1863). Others have thought it more applicable when the epilepsy was complicated with gastric disorder, and others again have seen the best results from it when used in conjunction with bromides or digitalis (Lancet, ii., 1868; Medical Times, ii., 1874, p. 481).
Charcot has observed benefit from the bromide of zinc (British Medical Journal, November, 1877), but Dr. Gowers, in his recent lectures, considers that salt of little value, and has found it badly borne. The oxide, however, in his experience, proved sometimes useful, relieving three cases out of ten submitted to it (Lancet, i., 1880, p. 553).