A Case of Epilepsy Treated by Luminal.

February, 1924

By G.N. MacDiarmid, M.D.

In October, 1922, Mr. J. McF. was brought to me by his wife, with a history of epilepsy. The attacks were almost invariably at night; occasionally they occurred while sitting up, and once while walking. The observations of Mrs. McF. were extremely detailed and intelligent. Commencing with the first attack in March, 1921, there had been no month without one, and the greatest number in any month was nine. On one occasion there were four in one night; the total number was 98. The attacks consisted of turning the head to the left with a jerking action while lying on the back; then a loud cry which woke all in the house; then twitching of hands (chiefly), body, and of face to a less degree; then laboured breathing; then a gradual relaxation. Attacks lasted for from five minutes to one hour. In the morning there was no memory of them. At times, irrespective of seizures, the patient was subject to violent manifestations of temper; once or twice he was violent towards his wife, bruising her against furniture.

The patient’s age was 58; there was pyorrhœa; urine normal; systolic B.P. 120. Otherwise I could find nothing abnormal. He gave a history of acute rheumatism and malaria as a youth. He had a fall from a cycle about three weeks before onset of attacks, when he bruised his right arm and right hip. He had previously been a good walker, but during the period of seizures had not walked more than a mile and a-half. His memory was becoming poor. The number of attacks per month showed a tendency to increase. I learned from his wife that he had had frequent courses of bromides, pushed till he was in a dazed condition; also that a blood test had been carried out, presumably a Wasserman.

There had been five seizures in the first ten days of October, 1922, and on the night of the 11^th October I started him on a course of luminal sodium (Beyer), directing him to take a one-grain capsule at bedtime. There was an immediate and absolute cessation of attacks for fifty-four days. During this time his memory improved; he showed no signs of violence or temper; he gained eight pounds in weight and took an interest in playing with his grandchildren. He enjoyed walks of from five to eight miles. This was in marked contrast to his former dull state, with the seizures increasing under bromide treatment.

On 5th December there was a recurrence of two attacks, and I at once increased the dose of luminal to gr. 1½. On four occasions—25th December and 7th, 26th, and 30th January—there were slight recurrences, but on each of these occasions the dose, for some reason, had been reduced to gr. 1. He had no further attacks while taking gr. 1½ till February, when there were two; on the second occasion consciousness was not lost. Luminal was then given in gr. 2 doses occasionally. On 26th April there were two, and again on 5th May, and irritability was complained of. I then gave gr. 1½ at nights and gr ½ in the mornings, and up till 15th June, when I last heard from him, there had been no more attacks. He was able to go backward and forward daily by train to a neighbouring town to carry on his work, that of a builder’s foreman. The general health of the man is vastly improved. It remains to be seen whether the dose will have to be still further increased, but inasmuch as the present quality is small, that would not present any difficulty. No bad effects have been observed.

A comparison of the number of seizures per month before and after commencing luminal will make it obvious that , instead of increasing as under heavy doses of bromides, they are very considerably reduced.

The actual numbers are as follow:—1921: March, 1; April, 1; May, 1; June, 4; July, 3; August, 5; September, 5; October, 8; November, 6; December, 7. 1922: January, 5; February, 4; March, 7; April, 5; May, 9; June, 5; July, 5; August, 6; September, 6; October, (10 days), 5. Luminal commenced: October (21 days), nil; November, nil; December, 3. 1923: January, 3; February, 2; March, nil; April, 2; May (five days), 2; May (26 days), nil; June (15 days), nil.