Vol. XXI

Original Articles

THE LUMINAL TREATMENT OF

EPILEPSY

JAMES M. STANTON, M. D.
DETROIT, MICH.

Among the patients that present themselves to the neurologist few can be found more common or more interesting that that great group characterized by recurrent convulsive seizures of a more or less stereotyped nature to which are given the name "The Epilepsies."

For the discussion of a type of treatment of a condition as ill defined as this entity; if it may be called an entity it would seem wise to first make clear the type of treated case from which my conclusions are drawn. At the present time epilepsy may best be regarded as a symptom, the result of an increased excitability of the cerebral cortex from stimuli of exogenous or endogenous origin.

It is obvious in view of this situation that the treatment of the condition must be based upon either the removal of the sources of the stimuli; or, of a lowering of the cortical threshold of excitability. It is obvious that the ideal method would be the removal of the sources of the stimuli. However, in a large proportion of the number of patients showing this disorder, the sources of stimulation are impossible of detection by our present means of physical and functional examination. It is largely in this group of patients that I have used luminal. There remains, also, a certain number of cases where the source of the stimuli is discoverable, but in which it is not possible to remove or effect the source of the excitation.

From this it is obvious that the therapeutic approach to a relatively large group of patients suffering with this disorder must depend upon measures that lower the threshold of cortical excitability. Up to within a comparatively short time, the posi

No. 1

tion of importance in this endeavor has been accorded the various preparations of bromide.

In 1912 Alfred Hauptman(1) reported the treatment of a series of cases of rather severe epilepsy with a new drug-Luminal. He was very favorably impressed with the use of this substance and reported no injurious by-effects of any kind after months of daily administration of this drug. Kutzinsky(2), Fuchs(3) and Debrowski(4) in 1914 reported separate series of cases treated with the drug. They all had observed either marked reduction in the number, or complete cessation of the seizures. Fuchs, however, spoke of the seizures recurring with greater frequency after withdrawal of the drug. Grinke(5) in a discussion of a paper by Dercum in 1916 was the first in this country to mention the use of Luminal. Dercum(6) in 1919 reported upon the use of the drug. He found that one and one-half to two grains of luminal given daily almost uniformly uniformly controlled or inhibited the seizures.

Grinke(5) reported in 1920 his experience with over one hundred cases of epilepsy treated with this drug. He has found that luminal in doses of one and one-half to two grains, once or twice daily, is capable of causing an arrest of convulsions in epilepsy. Some of his patients have been free from attacks for three to four years. He has observed no harmful effects from the long continued administration of this drug. He is thoroughly convinced of the superiority of luminal over the bromides in the treatment of these cases.

Kirk(7) presented a report of two hundred cases of epilepsy treated with luminal at the Arkansas State Hospital for Nervous Diseases. He reports an immediate decrease in the number of seizures in all cases and a complete cessation of the seizures in a large number of the cases. He remarks that no bad effects were observed on the kidneys, stomach, circulation, temperature and respiration. There is no evidence, he feels, to