General

Abstract

Reference to Flechsig's Bromo-opiate Treatment of Epilepsy was made in the last number of this Journal. Though the results chronicled have so far been few in number, the adoption of this form of treatment in severe or obstinate cases of epilepsy, especially when associated with pronounced mental disturbance, appears worthy of consideration. In the Zeitschrift f. Psychiatrie, Bd. lii., two communications have appeared, each of which gives most favourable results. Linke has administered opium and bromides in succession to seven epileptics, six males and one female, in all of whom marked psychical aberration existed. In rapidly increasing doses he exhibited opium first for six weeks, suddenly changing the medicament to large doses (7·5 grms.) of bromide, which being continued for another period of six weeks was then reduced to a daily dose of 5 grms. This is the method advocated by Flechsig, though other therapeutists have lengthened the periods of administration of each drug. Linke found that during the opium course the epileptic seizures increased greatly in number, and that the body weight in some cases showed a marked diminution. As soon as the bromides were substituted for the opium the fits immediately diminished in frequency, and the body weight in the affected cases increased again. The ultimate result of the treatment was that in one patient the seizures had not recurred from the commencement of the bromide course until the date of his paper; in another, one fit occurred on the third day after beginning the bromides, and then after an interval of freedom for nine weeks two seizures ensued; a third patient had a fit on the first morning of the bromide treatment, after which an interval of sixty-five days without fits elapsed, when the bromide had to be discontinued owing to bromism; five days after its withdrawal the patient had another fit. With reference to the mental condition two patients showed a comparative improvement, they became more cheerful and patient of control; one of these, who had been subject to accessions of intense furor, subsequently remained quite free from them. Two of his seven patients died during treatment, one apparently by reason of deleterious action of opium on an affected cardiac muscle, the other owing to exhaustion due to the epileptic status. In nearly all a moderate degree of constipation was induced when the daily doses of opium reached ·60 grms., easily overcome, however, by simple aperients. When the maximum dose of opium was reached serious symptoms supervened, which rendered careful observation of each case needful. As only two and a half months had elapsed between the commencement of the bromide course and the publication of his paper, Linke discreetly draws attention only to the remarkable effects of this mode of treatment in cases hitherto wholly uninfluenced by therapeutic measures; he certainly makes no claim for the method as a specific curative.