Having considered the general effects of the bromides on a series of unselected cases, we now proceed to investigate whether any particular form of the disease, or any special circumstances connected with the patient or his surroundings, have any influence in modifying the results of treatment. The following table shows epilepsy divided into its two chief forms, namely, E. Gravior and E. Mitior. By the former is understood the ordinary severe attack, with loss of consciousness and convulsions; the latter is the slighter and very temporary seizure, of loss of consciousness, but without convulsions.
Table V.—Showing Results of Treatment by the Bromides in—1. Epilepsia Gravior; and 2. Epilepsia Mitior.
| No. of Case. | Average number attacks per month before treatment. | Average number attacks per month after treatment. | Number of attacks during six months of treatment. |
|---|---|---|---|
| 1. Epilepsia Gravior. | |||
| 1 | 600 | 5 | — |
| 2 | 450 | 12 | — |
| 3 | 249 | 90 | — |
| 4 | 180 | 60 | — |
| 5 | 120 | 3 | — |
| 6 | 60 | 1 | — |
| 7 | 60 | 6 | — |
| 8 | 30 | — | 8 |
| 9 | 30 | 4 | — |
| 10 | 30 | 12 | — |
| 11 | 23 | 1 | — |
| 12 | 16 | 2 | — |
| 13 | 12 | — | 4 |
| 14 | 12 | 3 | — |
| 15 | 12 | 10 | — |
| 16 | 8 | 0 | 0 |
| 17 | 8 | — | 4 |
| 18 | 8 | 1 | — |
| 19 | 8 | 4 | — |
| 20 | 8 | 2 | — |
| 21 | 6 | — | 1 |
| 22 | 5 | — | 5 |
| 23 | 5 | 0 | 0 |
| 24 | 4 | — | 2 |
| 25 | 4 | 1 | — |
| 26 | 4 | 2 | — |
| 27 | 2 | — | 1 |
| 28 | 2 | — | 1 |
| 29 | 2 | — | 1 |
| 30 | 2 | — | 1 |
| 31 | 2 | — | 2 |
| 32 | 2 | — | 2 |
| 33 | 1 | 0 | 0 |
| 34 | 1 | 0 | 0 |
| 35 | 1 | 0 | 0 |
| 36 | 1 | 0 | 0 |
| 37 | 1 | 0 | 0 |
| 38 | 1 | 0 | 0 |
| 39 | 1 | — | 1 |
| 40 | 1 | — | 1 |
| 41 | 1 | — | 1 |
| 42 | 1 | — | 1 |
| 43 | 1 | — | 2 |
| 44 | 1 | — | 4 |
| 45 | 1 | — | 2 |
| 46 | 1 | 1 | — |
| 47 | 1 | 150 | — |
| 2. Epilepsia Mitior. | |||
| 1 | 900 | 60 | — |
| 2 | 600 | 60 | — |
| 3 | 300 | 3 | — |
| 4 | 150 | 1 | — |
| 5 | 150 | 7 | — |
| 6 | 120 | 120 | — |
| 7 | 90 | 9 | — |
| 8 | 90 | 3 | — |
| 9 | 60 | 15 | — |
| 10 | 60 | 90 | — |
| 11 | 13 | — | 2 |
| 12 | 16 | — | 4 |
| 13 | 16 | — | 8 |
| 14 | 8 | — | 3 |
| 15 | 8 | — | 3 |
| 16 | 4 | — | 1 |
| 17 | 4 | 6 | — |
| 18 | 1 | — | 4 |
Of 47 cases of E. Major, we find that in 8 there were no attacks during the whole period of treatment, in 1 there was no improvement, in 1 the attacks were augmented after treatment, and in 37 there was marked and varying diminution of the seizures. Of 18 cases of E. Mitior there was no case where the attacks were wholly suspended, in 1 there was no improvement, in 2 the attacks were increased, and in 15 they were diminished in number by treatment. This is scarcely a fair comparison between the two forms, as the numbers are so unequal; but cases of uncomplicated E. Mitior are not common, being generally associated with the graver form, which combined cases are not inserted in this table. It is generally asserted in books that the non-convulsive form is much more intractable than the other, but the above table proves the contrary, as, for example, in Nos. 3, 4, 11, 12. It is true that the results do not appear so complete or striking in E. Mitior as in E. Gravior, but then it must be remembered that the number of cases is more limited, and the number of attacks originally much greater. In short, the table shows that if treatment does not completely avert the attacks of E. Mitior, it greatly diminishes their frequency.
TABLE VI.—Showing Effects of Treatment by the Bromides in Epilepsy. 1. Diurnal Form; 2. Nocturnal Form.
| No. of Case. | Average number attacks per month before treatment. | Average number attacks per month after treatment. | Number of attacks during six months of treatment. |
|---|---|---|---|
| 1. Diurnal Form. | |||
| 1 | 300 | 3 | — |
| 2 | 90 | 9 | — |
| 3 | 60 | 6 | — |
| 4 | 30 | — | 8 |
| 5 | 24 | 1 | — |
| 6 | 16 | — | 8 |
| 7 | 12 | — | 4 |
| 8 | 8 | — | 3 |
| 9 | 8 | — | 4 |
| 10 | 4 | 1 | — |
| 11 | 2 | — | 1 |
| 12 | 1 | 0 | 0 |
| 13 | 1 | 0 | 0 |
| 14 | 1 | 0 | 0 |
| 15 | 1 | — | 1 |
| 2. Nocturnal Form. | |||
| 1 | 60 | 1 | — |
| 2 | 16 | — | 4 |
| 3 | 8 | 2 | — |
| 4 | 2 | — | 1 |
| 5 | 4 | — | 2 |
| 6 | 1 | — | — |
| 7 | 1 | 150 | — |
Another variety of epilepsy is that which is characterized by the time at which the attacks occur. In the large majority of cases these take place both while the patient is awake and when he is asleep. I have, unfortunately, no observations to offer as to the effects of treatment on the diurnal or nocturnal attacks in patients suffering from both. The preceding table shows the result of treatment in 15 cases in which the attacks occurred only while the patient was awake, and in 7 cases where they took place only while he was asleep.
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.