J. M. FRENCH, M. D., MILFORD, MASS.
In the May number of the THERAPEUTIST, Dr. Thomas B. Turnbaugh asks for a cure for epilepsy, having found in his professional experience that all of the vaunted remedies fail to cure. He refers especially to verbenin, which is a concentration of verbena hastata, as a drug which he has seen favorably spoken of in the journals, but concerning which he has not been able to obtain much information.
I am not going to recommend any drug or combination of drugs as a specific in epilepsy, for I do not believe there is such a thing at present known. I will, however, with your permission, gladly say a good word for verbenin, as a remedy which has given me good results, and which I believe to be of value in many cases of this disease.
Epilepsy is a disease having a wide range of causes, and requiring an intelligent and many-sided treatment. It belongs to that class of maladies of which it has been well said that the only way to be cured, is never to think that you are cured. A nervous system which has once suffered from a series of epileptic paroxysms, will ever after be more than normally susceptible to the exciting causes of such paroxysms, and hence will demand great care to prevent their recurrence.
In the treatment of epilepsy, it is necessary as the first step to search high and low for the exciting cause, and remove it if possible. If no evident cause can be found, then treat every recognized deviation from the normal, as in a susceptible person almost any abnormality may serve as an exciting cause of the convulsive attacks.
Next comes the necessity of regulating the diet and habits of life. In proportion as these can be controlled, and also in proportion to the length of time the disease has existed, is the probability of cure.
Coming now to the medical treatment, in the leading text-books you will find little recommended but bromides. These deaden the sensibility of the nervous system, and sometimes make the patient distinctly worse. One such case—a woman of sixty, who had been an epileptic since puberty—came under my care five and a half years ago, and has been treated with verbenin almost without intermission since that time, with of course such other remedies as may have been indicated by the general symptoms, with the result that the patient has been free from attacks at one time for 22 months and again for 34 months. After the first few weeks of treatment, there have been but two periods of recurrence. The first of these lasted several months, during which there were numerous severe attacks. The second lasted not more than two weeks, in which time there were four light attacks. In both recurrences, the evident cause was mental excitement and worry.
Another case was that of a girl of seventeen, epileptic four years, who had no attack for four months after beginning treatment, and would not then, in my opinion, had I not consented to let her return to school. She was ambitious and studious, and was soon trying to lead her class. Under these circumstances, she had a single convulsion. She then gave up school for good, and has thus far had no more, and is in excellent health. This was only about six weeks ago, however, and it is too soon to build on the results.
One strong point in its favor is the fact that verbenin has no injurious or unpleasant effects, but its use makes the patient brighter and more cheerful and alert, instead of dull and stupid, as is the case with bromides.
I have found this remedy especially useful in those cases where bromides did no good, or even made the patient worse. On the other hand, when the effect of the bromides is favorable, verbenin may make the patient worse, and if so should be abandoned.
It happens that all of my experience with this drug has been with the concentration, verbenin, one grain of which represents thirty grains of the crude drug. I do not suppose, however, that this preparation possesses any particular advantages over the crude drug, other than those of palatability and convenience of administration, as the fluid extract is an exceptionally nauseating and disagreeable preparation.
The standard tablets contain one-third of a grain of the concentration, and hence are equivalent to ten grains of the crude drug. I usually begin with one tablet before each meal, and increase by one tablet a day—not one before each meal—until the patient is taking fifteen tablets a day. From this dose I have never seen any disagreeable symptoms whatever, and the improvement which it works in the nervous system of the patient, even outside the convulsions, is very gratifying. Should the effect not be favorable, that is, should the convulsions continue unabated, or grow more severe or frequent, then the indication is to stop the treatment and try some other plan. I do not claim that verbenin will cure or even benefit every case of epilepsy. In my experience, however, it has done this in a larger proportion than any other remedy I have ever used, and I am especially desirous of determining just what class of cases it will help, and what ones it will not help—in other words, of determining the exact indications for its use.
I shall be glad of help from any of your readers in my efforts to do this, and shall also be glad to help any of them to all the information I may be able to give them in reference to the nature of this drug and the mode of using it. And whatever you do, do not forget that the three steps in the treatment of epilepsy are, (1) Remove the exciting cause whenever possible; (2) regulate the diet and habits of life; (3) drug medication.
Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.