Part 7

Of 15 cases of the purely diurnal form, we find that in 3 there was a total cessation of attacks during treatment, and in all the others there was diminution in their number. Of the 7 nocturnal cases, in none were the seizures entirely arrested, in 1 the attacks increased in number after treatment, and the remainder were relieved to a greater or less extent. Here, again, our numbers are small, and therefore difficult to found any definite principle upon; still there is enough to show that, contrary to the opinion expressed by most authorities, the nocturnal form of epilepsy appears to be as amenable to relief as the diurnal variety.

The next point for consideration is the question whether the fact of the epilepsy being hereditary or not makes any difference in the results of treatment by the bromides. In the following table all the cases with a perfectly sound family history are placed in the first part, and the second includes those in which either epilepsy or insanity could be proved to exist in any near relation.

Thus in 39 cases with a perfectly sound family history, in 3 the attacks were totally arrested during treatment, in 2 there was no improvement, in 2 there was increase of seizures after treatment, and in the remainder there was diminution of the fits. In 18 cases, where at least one near relation suffered from either epilepsy or insanity, in 3 the attacks were arrested, in 1 they were increased, and in the remainder diminished. In short, from a review of the details of the table, it does not appear that the fact of the disease being inherited, or of its existing in other members of the family, makes any difference to the benefit we may expect to derive from treatment.

TABLE VII.--Showing Effects of Treatment by the Bromides in Epilepsy. 1. Non-Hereditary Cases, 2. Hereditary Cases.

Average Average Number No. number number attacks of attacks attacks during Case. per month per month last 6 before after months of treatment. treatment. treatment.

1. Non-Hereditary Cases.

1 600 5 -- 2 600 60 -- 3 450 12 -- 4 240 90 -- 5 300 3 -- 6 150 7 -- 7 120 3 -- 8 120 120 -- 9 150 1 -- 10 70 20 -- 11 60 6 -- 12 60 90 -- 13 60 1 -- 14 30 12 -- 15 90 3 -- 16 30 -- 2 17 16 -- 4 18 16 2 -- 19 8 0 0 20 8 2 -- 21 8 -- 3 22 8 4 -- 23 6 -- 1 24 5 0 0 25 5 -- 5 26 4 2 -- 27 4 1 -- 28 2 -- 2 29 2 -- 1 30 2 1 -- 31 2 -- 2 32 1 0 0 33 1 -- 2 34 1 -- 4 35 1 1 -- 36 1 -- 1 37 1 -- 1 38 1 -- 1 39 1 150 --

2. Hereditary Cases.

1 900 60 -- 2 180 60 -- 3 90 9 -- 4 24 1 -- 5 16 -- 8 6 12 -- 4 7 12 3 -- 8 8 1 -- 9 8 -- 3 10 8 -- 4 11 4 -- 2 12 4 6 -- 13 2 -- 1 14 2 -- 1 15 1 0 0 16 1 0 0 17 1 0 0 18 4 -- 1

The next table attempts to show whether or not the age of the patient when he came under observation has any effect in modifying the action of the bromides, or whether it assists us prognosing the probable result.

A survey of this table shows in general terms that the age of the patient is neither an assistance nor impediment to the successful action of the bromides in the treatment of epilepsy. Whatever the age may be, whether in a young child or in an old person, the average of beneficial effects appears to be the same. At first sight it would seem as if treatment would be more successful in the young; but it is not so, as the two cases in the table over fifty years of age received as much average benefit as any of the others.

TABLE VIII.--Showing Effects of Treatment by the Bromides in Epilepsy at Different Ages. 1. Under 15 Years; 2. Between 15 and 30 Years; 3. Between 30 and 50 Years; 4. Over 50 Years.

Average Average Number No. number number attacks of attacks attacks during Case. per month per month last 6 before after months of treatment. treatment. treatment.

1. Under 15 Years.

1 900 60 -- 2 600 5 -- 3 600 60 -- 4 450 12 -- 5 240 90 -- 6 180 60 -- 7 150 7 -- 8 30 4 -- 9 8 0 0 10 8 -- 3 11 4 6 -- 12 4 2 -- 13 2 -- 1 14 1 150 --

2. Between 15 and 30 Years.

1 300 3 -- 2 150 7 -- 3 120 3 -- 4 120 120 -- 5 90 3 -- 6 60 1 -- 7 60 6 -- 8 60 90 -- 9 16 -- 4 10 16 -- 8 11 16 2 -- 12 12 -- 4 13 8 1 4 14 8 2 -- 15 8 4 -- 16 70 20 -- 17 5 0 0 18 4 -- 2 19 4 1 -- 20 4 1 -- 21 2 -- 2 22 2 -- 1 23 2 -- 1 24 2 -- 2 25 1 0 0 26 1 0 0 27 1 0 0 28 1 -- 1 29 1 -- 2 30 1 -- 4 31 1 1 --

3. Between 30 and 50 Years.

1 30 -- 2 2 30 -- 12 3 12 3 -- 4 8 1 -- 5 8 -- 3 6 5 -- 5 7 2 -- 2 8 1 0 0 9 1 -- 1 10 1 -- 1

4. Over 50 Years.

1 30 -- 8 2 24 1 --

Does the fact of the disease being recent or chronic affect the prognosis of treatment? This will be seen by the following table, in which the length of time that the disease has existed is divided into four periods, namely--1, those cases in which the attacks first began less than a year before treatment was commenced; 2, those in which they had begun from one to five years before; 3, those in which they began from five to ten years before; and, 4, those in which the disease had existed for over ten years.

TABLE IX.--Showing Effects of Treatment by the Bromides in Epilepsy in Recent and Chronic Cases. 1. Under 1 Year; 2. From 1 to 5 Years; 3. From 5 to 10 Years; 4. Over 10 Years.

Average Average Number No. number number attacks of attacks attacks during Case. per month per month last 6 before after months of treatment. treatment. treatment.

1. Under 1 Year.

1 600 60 -- 2 60 6 -- 3 8 -- 3 4 5 0 0 5 4 -- 2 6 4 2 -- 7 2 -- 1 8 2 -- 1 9 2 -- 2

2. From 1 to 5 Years.

1 600 5 -- 2 240 90 -- 3 180 60 -- 4 90 3 -- 5 30 -- 2 6 30 -- 8 7 30 12 -- 8 16 -- 8 9 12 3 -- 10 8 0 0 11 150 7 -- 12 8 2 -- 13 6 1 -- 14 4 -- 1 15 2 -- 1 16 2 -- 2 17 1 0 0 18 1 0 0 19 1 -- 1 20 1 1 -- 21 1 150 --