Some cases of epilepsy, suffering but infrequently from seizures - perhaps only at night - and being free from psychic disability, can and do, with the aid of occasional medical advice, lead normal lives.

For the bulk of cases, however, some provision of control and management is required. The treatment of these cases will be discussed briefly under the following captions: (1) Prevention. (2) Education and training. (3) Social service. (4) Hygienic measures. (5) Medication. (6) Treatment of special manifestations.

(1) Prevention

This is eminently a problem in eugenics, the factor of heredity being the all important one in the etiology.1 The segregation of epileptics in institutions is a practice which is rapidly growing in the United States, so that the outlook for the future is exceedingly encouraging. The National Committee for Mental Hygiene reports in its second annual census of the insane, feeble-minded, epileptics and inebriates in institutions in this country that on January 1, 1918, there were 11,944 epileptics in public and private institutions. This is undoubtedly an understatement, as "No attempt was made to secure data from almshouses, penal or reformatory institutions." 2 Some states maintain special institutions for epileptics, which would seem to be the best plan. Others provide for their care and treatment in institutions for the insane or feeble-minded.

(2) Education And Training

For some cases of epilepsy this presents no special problems. But many others, being complicated with various degrees of mental defectiveness, require special provision such as has already been discussed in the chapter on Arrests of Development.

(3) Social Service

Epileptics often go into occupations which are dangerous to them or for which they are not suited; more often they lose their jobs when, owing to seizures while at work, their malady is discovered. They can be greatly benefited through social service by being placed in suitable employment under conditions of full understanding with employers concerning their trouble.1

1 C. B. Davenport and D. F. Weeks. A First Study of Inheritince in Epilepsy. Bulletin No. 4, Eugenics Record Office, Cold Spring Harbor, N. Y.

2 H. M. Pollock and E. M. Furbush. Annual Census of the Insane, Feeble-minded, Epileptics, and Inebriates in Institutions in the United States, January 1, 1918. Mental Hygiene, Jan., 1919.

(4) Hygienic Measures

These consist mainly in special diet, abstinence from alcohol, and outdoor life with moderate physical and mental labor. It has been shown by dietetic experiments 2 that epileptics have a special intolerance for proteid material in any form, and that when their diet contains more proteid than the minimum required by the organism their convulsions are more frequent and more severe and their mental condition is worse than when their diet contains no such excess. The principal dietetic indication is, therefore, to reduce the amount of proteid to the minimum required by the organism.

(5) Medication

Of all the drugs used in the treatment of epilepsy we shall mention only the bromides of the alkali metals and luminal.

The bromides of sodium and potassium are administered either separately or in a mixture of the two with bromide of ammonium, which mixture is sometimes known as the "tribromide." The doses vary according to age, frequency of attacks, and tolerance of the patient. The maximum that may be administered to an adult with benefit seems to be from 8 to 10 grams daily. Usually good results can be obtained from moderate doses - from 3 to 6 grams daily.

The action of the bromides seems to be more pronounced when the patient is allowed a "hypochlorization" diet; that is to say, a diet in which the amount of sodium chloride is reduced as far as possible (Richet and Toulouse).3

1 Margherita Ryther and Mabel Ordway. Economic Efficiency of Epileptic Patients. Journ. of Nerv. and Mental Disease, May, 1918.

2 Merson. On the Diet in Epilepsy. The West Riding Lunatic Asylum Medical Report, 1875. - Rosanoff. The Diet in Epilepsy. Journ. of Nerv. and Mental Disease, Dec, 1905, and Dec, 1909.

3 Capeletti and Ormea. he regime achloruri dans le traitement bromure de Vepilepsie. Rev. de Psychiat., Apr., 1902.

The prevailing opinion among neurologists is against the routine administration of bromides in epilepsy. The principal indication for their administration would seem to be frequent and severe seizures with progressive deterioration. The course of medication should be interrupted by periods of a month or two of suspension of medication.

Luminal in doses of 1^ grains at bedtime has been highly recommended of late by Dercum and others. "In a number of instances the use of luminal as here indicated has resulted in the abolition of the convulsive seizures for periods extending not only over many months, but even over several years." 1

(6) Treatment Of Special Manifestations

Excitement, such as occurs in epileptic delirium, has to be treated by methods already outlined in Chapter VIII (The Practice Of Psychiatry. General Therapeutic Indications), Part I, of this Manual.

Status epilepticus, i.e., continuous repetition of seizures without interval of consciousness lasting a day or longer and often terminating in death, must be promptly combated with an enema of soapsuds followed by per high rectal injection given slowly. A similar injection should be given again at the end of an hour if necessary. If at the end of two hours after the second injection the seizures still continue, ether inhalations may be given cautiously so as to avoid producing inhalation pneumonia. Hypodermic stimulation with strychnine or caffeine may be given in case of threatened collapse from exhaustion. As long as the condition lasts rectal feeding is to be preferred.

Chloral hydrate........................

1 gram

Potassium bromide.....................

2 grams

Water................................

120 c.c.

1 F. X. Dercum. On the Complete Control of Epileptic Seizures by Luminal. Therapeutic Gazette, Sept. 15, 1919.