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.
In true epilepsy it has, like most other nerve-tonics, been used and commended, but evidence of its really preventing the attacks is contradictory. Broadbent found it useful in epileptiform vertigo (Practitioner, viii.-x.), and Anstie observed it relieve the depression of epileptics and improve their temper and power of control (Medical Times, i., 1862). In the early period of the disease, when dependent upon sexual abuse, I have known phosphorus prove very beneficial. I remember especially the cases of two men, aged nineteen and twenty-three, whose attacks began soon after puberty, and who had taken large doses of potassium bromide without evident relief, and who became quite freed from their attacks during a course of phosphorus, and have continued free from them during the four and six years that have since elapsed. The dose was only 1/100 gr. three times daily, which was continued (irregularly) for twelve or fifteen months.
Magendie stated that he had cured this disease by iodide of potash, and Franklin gave to a boy, aged eight years, as much as 180 to 300 drops of iodine tincture, and curiously enough the boy bore it well and was cured (Kohler).
It seems to me that the remedy can only serve in such cases if there be a syphilitic or rheumatic origin.
For this malady the bromides are now, by common consent, held to be the most generally reliable remedies. They give the best results in sthenic cases of uncertain causation, when convulsive attacks are very violent, but have not become chronic. Attacks connected with tumor, or injury, or organic lesion, are also more or less relieved, probably in proportion to the amount of hyperoemia present. Dr. Wilks found better results from bromides in traumatic cases than in any other (Medical Times, ii., 1861, p. 635), and Dr. Broadbent noticed the same fact (Lancet, i., 1866, p. 92). Where there is excentric irritation, as in the generative system or the abdominal organs, benefit is almost always obtained, and Dr. Bill has compared the action of bromides in such cases to that of a ligature, interrupting communication between an impression or "aura," and the brain; they seem to diminish not only conductive, but reflex function. In a case in my own practice, where a large uterine fibroid produced alarming epileptiform symptoms, opium invariably increased the spasms, but bromides relieved quickly.
Minor forms of epilepsy, as "petit mal," evidenced by transient vertigo or loss of consciousness, with perhaps some spasm, but not true convulsion, are not so certainly relieved; and when the epileptic attacks occur only, or chiefly, at night, and at long intervals, bromides are not always the best remedies; also in very chronic cases of many years' duration, they can usually do little more than modify the character of the attacks. When the patient has become nerveless and stupid, belladonna has the advantage over bromides, and when there is marked anaemia or profound depression, they are not desirable. Nux vomica, or strychnia, in small doses, will act better, especially if consciousness be not completely lost during the fits. It must be noted, however, that according to statistics recently published by Dr. A. Hughes Bennett, all varieties of the disorder - petit mal, nocturnal or chronic epilepsy - have shown good results in large proportion under bromide treatment (Edinburgh Medical Journal, February 7, 1881).
Supposing the case be one suitable for this, it is important for success that it should be carried out thoroughly, in sufficient doses, and continued sufficiently long. It must not be interrupted as useless in any case, unless distinct evidence of its physiological effect has been obtained without relief to the symptoms. The production of drowsiness, or of a characteristic skin-eruption, may be taken as some guide, but a better one will be found in the degree of insensibility produced in the fauces; if no irritation or retching is caused by touching the uvula or pharynx, then probably the patient is under bromic influence. From 10 to 40 gr. thrice daily is an average limit, more being given at night-time, if necessary. At first, even larger quantities may be required, and many instances of success from very large doses are on record. Puche and other French physicians have given 100 and 200 gr., but not without some vomiting and prostration (Medical Times, i., 1874). Dr. Squibb found 60 gr. act well when less failed; and he notes that, if the medicine needs to be omitted for a time, it should be resumed at the full dose again. Dr. Farquhar-son gave 30 gr. four times daily with benefit, to a child aged five; and Dr. F. Beach, at the Clapton Asylum, commonly gives 15 gr. every two hours for a time, and 1 or 2 dr. during a paroxysm (British Medical Journal, ii., 1877). Thirty grains thrice daily have been taken for twelve years, and although before treatment the patient was incapable of work, he became equal to the conduct of an ordinary business (ibid, p. G55). There was no effect on the sexual power. I have often myself given similar large doses, and for a long period; but there is no one rule to follow, as I have found 10 gr. act as effectively in some cases as 60 gr. in others. Sometimes 5 gr. will cause troublesome acne.
When the attacks are once controlled, a single daily dose of from 2D to 60 gr. will usually suffice to keep up the effect, and may have to be continued for many months or years. Bromide, indeed, has been well called the "food of the epileptic," and sometimes needs to be taken as regularly as food; still, an occasional intermission - one or two days in a week or fortnight - is usually desirable, for thus the effect of the medicine is better preserved, with less injury to the patient. It is necessary to watch carefully its effect on the general health, and to omit it, or at least to lessen the dose, if the skin should be much affected, the extremities become cold, or anaemia, prostration, or diminished sexual power be traced to it. In exceptional cases there has been developed, under bromides, a peculiar general irritability of asthenic character, or even an excited condition resembling mania (Sequin, Voisin). Minor symptoms, such as headache, "stuffiness" of head, lachrymation, and gastric irritation, have been connected with the use of a preparation adulterated with iodide (Legrand du Saulle: Medical Times, i., 1872, p. 319). If during the omission of treatment convulsion threatens to return, bromide should be at once resumed, but perhaps in a different combination.