EPILEPSY—Probably in few other disorders has folk medi­cine been so futilely inadequate as in epilepsy.

Known since antiquity, epilepsy—which in Greek means seizure—was an enigma up until some 25 years ago. Hardly more than 200 years ago some of Europe's leading doctors said it was the work of witches. Centuries before that the sufferers of the "falling sickness" were thought to be possessed by demons.

Despite the undeserved stigma attached to the affliction in the dark ages, and even into our own age, the world, para­doxically, has honored a good number of epileptics, including Julius Caesar, Alfred the Great, Lord Byron, Algernon Charles Swinburne, Guy de Maupassant, Paganini, and Van Gogh.

Some of the early treatments tried for epilepsy were in the same category as those used for the mentally deranged. Pos­sibly some of the first cases of trephining of the skull were inspired by epileptic seizures of the victims. Later those who were believed to be possessed by demons were frequently tortured beyond belief.

Today the medical picture of epilepsy is more encouraging. In the great majority of cases, drug therapy can control epilepsy. Most of this medical advancement in diagnosis and treatment of epilepsy has come over the last 25 years or so. Dr. Howard B. Fabing, past president of the American Acad­emy of Neurology has said that they have been, "greater than those of the last 25 centuries."

For the million and a half Americans who have been diag­nosed as epileptics this has been important news. It means that between 80 and 90 per cent of them can lead fairly normal lives, either completely or partially free from con­vulsive seizures. It means that many can now hold jobs— about 16 out of 20.

There are four groupings of seizures. Each of them is different from the others.

A young woman attending business college began to have what she believed to be "fainting spells." She was from out of town and living in a boarding house. After her attacks she was never quite certain what had happened to her. Finally she visited a neighborhood physician.

The doctor, young and alert, suspected a certain type of epilepsy and ordered special diagnostic tests. One, called an electro-encephalogram ("E.E.G."), records the electric cur­rents given off by the brain. It is a simple, painless test. The wave patterns inspired by the electric currents from the brain are recorded on paper. Each of three main types of epileptic seizures is indicated by a pattern different from other types.

Occasionally, if it is suspected that a scar or tumor on the brain may be causing seizures, a special type of X-ray picture may be taken. It is called a pneumoencephalogram.

The young woman was diagnosed as an epileptic and was put on drug therapy which was effective. The "fainting spells" stopped.

The parents of a small 11-year-old boy were alarmed when he began to have "attacks." Abruptly he would begin to tremble violently, throw his arms out, rub his eyes, and frequently fall down.

The doctor diagnosed his illness as epilepsy. With proper treatment he continued to attend school and lived a normal life.

In the grand mal attack the patient loses consciousness, muscles tighten, he falls. Sometimes he calls out or groans. Saliva wets his lips. His face becomes dusky and then pale. For a moment or so he twitches violently and then lies relaxed.

The petit mal attack is described by Dr. Tracy Putnam: "The patient was sitting calmly in the office, discussing his symptoms. He stopped in the middle of a sentence, stared vacantly, blinked, and went on with what he was saying, only slightly confused."

The psychomotor type is the most difficult to diagnose. About a third of adult epileptics fall into this diagnosis. In a seizure the patient is amnesic, appearing to be conscious, but failing afterwards to remember anything that happens.

In a Jacksonian seizure the beginning is marked by twitch­ing or numbness of one leg, arm, side of the face, or trunk of the body. It gradually spreads to the greater portion of the person.

About half of our epileptic patients have some kind of warning that an attack is impending. It may be a "queer feeling" or giddiness, or disturbed vision.

Although bromides were used to treat epilepsy after the Civil War, phenobarbital was used more intensively later on. In 1937 the greatest advancement in drug treatment came with the marketing of Dilantin as a result of work started in 1935 by Tracy Putnam and Houston Merritt, then with the Har­vard Medical School, in a search for a new anticonvulsant drug.

New anti-epilepsy drugs have appeared frequently since Dilantin was discovered until there are now around 15 or more, but as yet no one drug will control all the main types of epilepsy. Thus it is necessary to administer at least one drug for each type of seizure the patient experiences.

The standard procedure is to start with a small dose and gradually increase dosages until seizures are controlled, or until untoward side effects appear.

Some of the drugs used include: for grand mal, Dilantin (Epamin, Epanutin), phenobarbital, Mesantoin, Mysoline, and Mephobarbitol; for petit mal triodine may be prescribed, as well as paramethadione, Milontin, and glutamic acid. Other anticonvulsants, sedatives, and bromides may be used.

The greater effectiveness of today's drugs may be illustrated in a simple comparison made by the Public Affairs Com­mittee, Inc., which showed some time ago that a patient who had 20 attacks per month had them reduced to 10 through use of a bromide—to 7 with use of phenobarbital—and to 2.5 per month with the use of Dilantin.

Dr. Howard D. Fabing, of Cincinnati, believes more than 80 per cent of persons with seizures who are not otherwise incapacitated can now join the rest of society as "normals" according to a news release in Science Digest, September, 1960.

Gerald Walker, writing for Pageant magazine, December, 1960, says:

But whether the cause of their case is known or unknown, eight out of ten epileptics who formerly experienced repeated temporary loss or impairment of consciousness can now lead relatively normal lives. With the help of 15 anti-epilepsy drugs, seizures can be totally eliminated in half the cases of epilepsy, and greatly reduced in number and intensity in another 30 per cent.

Unfortunately, while the outlook for the epileptic has been brightened beyond words by medical progress, and so many of them now can lead normal lives, some of the legal obsta­cles placed before them are as outdated as were some of the misconceptions about the disorder years ago.

A number of states prohibit the marriage of epileptics. Laws in 17 states specifically stipulate that epileptics who are institutionalized may be sterilized against their wishes. Except in one state, South Dakota, epileptics are either denied driv­ers' licenses or are issued limited ones—even in the case of those who have had no seizure for twenty years or more.

Many schools refuse to accept epileptics, and no one knows how many firms refuse to employ one.

Dr. Pearce Bailey, former director of the National Institute of Neurological Diseases is quoted as summing up the prob­lem in these words: "Epilepsy is the only common disorder where the sufferer is more handicapped by the attitude of society than by his disability."

CEREBRAL PALSY—There are more than 600,000 victims of cerebral palsy in this country, approximately 250,000 of them under 21.

The disorder is known as a "multi-crippler" because, unlike other disorders of the central nervous system which affect only one part of the body, cerebral palsy is manifested in combinations of impairments.

CP is caused by brain damage which may occur before, during, or after birth. About 30 per cent is thought to origi­nate before birth, and 60 per cent during the interval between the start of labor pains and completion of the birth.

There is no "cure" for the disorder since damage to the brain tissue cannot be repaired. Curare or mephenesin has been used for the spasticity of the disorder, but only transient benefit has been obtained from such treatment.

The fight against the disorder is centered upon prevention through better prenatal care, reduction of accidents, infection control, rehabilitation of the victims, and education.

A large task force is engaged in such work, including the United Cerebral Palsy Association, Inc., the National Insti­tute of Neurological Diseases and Blindness, the Crippled Children's Service of the United States Children's Bureau, and the Office of Vocational Rehabilitation. In 1959 an ef­fort to enlist 400,000 prospective mothers in research studies brought thousands of volunteers.

From such studies comes encouraging news. As Albert Q. Maisel reports in Reader's Digest, January 1961, "Cerebral palsy, epilepsy and a number of mental abnormalities have long been blamed on both heredity and injuries during deliv­ery. Many researchers today believe, however, that deficien­cies of the oxygen supply to the fetus account for a substantial number of these birth defects."

The next few years may bring encouraging results in ef­forts to prevent cerebral palsy.

MULTIPLE SCLEROSIS—Multiple sclerosis—MS—was rec­ognized as a disease only little more than one hundred years ago, yet today it strikes fear in the hearts of many, and is called "the foremost neurological problem of our time" by Dr. Thomas M. Rivers of the National Foundation in New York.

The disease, sometimes called "creeping paralysis," comes from unknown causes. The disorder is suffered by around 250,000 persons.

In his book My Fight To Conquer Multiple Sclerosis, Hin-ton D. Jonez, M.D. says this about those afflicted: "Most victims are in the prime of life. They are between twenty and forty years of age and in their otherwise most productive period. Usually they are married. Frequently there are young children who depend upon them. These are some of the factors that make M.S. a national problem."

Although scientists are not certain about the cause of M.S., for some time they have known that a fatty substance sheath­ing nerve fibers, myelin, is removed or destroyed, leaving nerve impulses exposed and distorted. Now scientists have discovered that a structure in the nervous system, the glial cell, which produces the protecting myelin sheath, is actually what degenerates in multiple sclerosis, and not the myelin.

Thus, step by step, scientists are approaching a possible solution to what causes multiple sclerosis. Other factors are being researched, including the hereditary factor and climate.

Meanwhile, as research continues for the cause and treat­ments, more and more attention is being directed toward the immediate care of patients through treatment clinics and advice centers.

MUSCULAR DYSTROPHY—One of the most intensive medical research projects now in action is concentrating its efforts on finding the cause of muscular dystrophy and devis­ing effective treatment.

Another of the central nervous system disorders, the ail­ment claims about 200,000 victims in the United States. Two-thirds of them, according to estimates, are between the ages of three and thirteen.

Muscular dystrophy is a progressive weakening of body muscles, especially of the chest muscles. Because it can so affect respiratory functions, it frequently brings death by direct interference with lung action.

A child with muscular dystrophy is in danger from the slightest cold.

Treatment has emphasized physical therapy, orthopedic supports, exercise, and patient care.

A modern research center costing more than $5 million was opened in New York in 1959. It is called the Institute for Muscle Disease. Here, under the direction of Dr. Ade T. Milhorat, research into neuromuscular diseases, mainly mus­cular dystrophy, will be thoroughy pursued. Again—as with so many other diseases—the answers may be waiting in the laboratories.

As yet there is no specific therapy for the disease. Several modes of drug therapy have been recommended now and again, but none has proved to be of definite value, it is authoritatively stated.

For their psychotherapeutic value in the disease, some vitamin preparations, including Bl, B2, and nicotinic acid may be given.

Experiments have been conducted with certain anticoagu­lants, but they may cause severe hemorrhages. Temporary beneficial results have been obtained occasionally through ad­ministration of cortisone and coiticotropin, but such treat­ment has not appreciably affected the course of the illness.

Physiotherapy is an important part of present treatment, with massage and passive movement of spastic, weakened limbs proving beneficial. Muscle training also is used to help the patient.

Climate may have something to do with the ailment since Northern Europe, for instance, reports a high incidence of the disease while it is relatively unknown in tropical climates.

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