The borderland of epilepsy : faints, vagal attacks, vertigo, migraine, sleep symptoms and their treatment.

  • Gowers, W. R. (William Richard), 1845-1915.
Date:
1907
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Licence: In copyright

Credit: The borderland of epilepsy : faints, vagal attacks, vertigo, migraine, sleep symptoms and their treatment. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    able it is evident that effective treatment has yet to be discovered. The most important lesson they convey is that no statements are to be trusted that are not based on genuine cases of the disease, and these are sufficiently rare to explain our lack of definite knowledge. The transitional disturbance that occurs on passing from the waking to the sleeping state, somnolescent disturbance, is often obstinate, whatever its form ; especi- ally the symptoms that are of motor nature ; the starts, for instance, are often uninfluenced by bromide, which might be expected to have a sure effect. This agent seems to act upon the higher rather that the lower centres, and the disturbance of the latter, which occurs during the with- drawal of the higher influence, may go on unchecked by it. Some other hypnotics, which promote the onset of sleep, have more effect, especially hyoscine, in doses of about y^q- grain. Sulphonal and trional have less influence, but paraldehyde is sometimes successful. The object of these agents is to break the spell of habitual tendency, and when this is achieved they should be gradually discon- tinued. Whatever is employed must be given at least an hour before the time at which it will be needed, so that its influence may be fully exerted when somnolescence comes on. In all forms of disturbance, whether initial or during established sleep, care should be taken to avoid evening mental excitement, the effects of which often continue throughout the night, and also to avoid all causes of gastric disorder. The relation of the stomach to sleep is familiar and mysterious. We do not know whether it is due to derangement of the gastric nerves, influencing the state of the brain, or to some product of imperfect diges- tion acting through the blood. The fact that an evening meal, which is difficult of digestion, may have a pro- nounced effect, suggests that the disturbance is through