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WATER METABOLISM IN EPILEPSY
WATER METABOLISM IN EPILEPSY
THE LANCET LONDON: SATURDAY. FEBRUARY 29, 1936
WATER METABOLISM IN EPILEPSY DURING the past few years the field of epilepsy research has been inundated with water. flood reached its height a year or two ago, and, having damped the ardour of all but a few enthusiasts, has since been receding rapidly, so that it is now possible to take stock of the situation. Apart from a few damp patches, the field seems remarkably unchanged. The idea that epilepsy might have something to do with water metabolism is not new. HIPPOCRATES is credited with the statement that " whoever is acquainted with such a change in men and can render a man humid and dry, hot or cold by regimen could also cure this disease-without minding purifications, spells and all other illiberal practices of a like kind." LENNox and CoBB have aptly paraphrased this as follows : " Whoever is acquainted with physiology and can render a man acidotic, dehydrated and fully oxygenated could also repress this disease, without minding purification of narcissistic personalities, ritualistic empirical diets and all other illiberal practices of a like kind." Both the original dictum and the paraphrase have been frequently repeated, in our own columns and elsewhere, and they stand repetition. But neither the Father of Medicine nor his interpreters would be pleased to see their words construed as meaning that epilepsy is due to waterlogging of the brain. It is true that modern research has confirmed the intuition of HIPPOCRATES in that it has shown that anything conducive to dehydration-be it starvation, a ketogenic diet, or drastic restriction of fluid intake-will often lessen the frequency of fits in the epileptic, and that on the other hand forcing of fluid will precipitate convulsions. But it is a perilous jump from these facts to the conclusion that epilepsy is an expression of disturbed water balance. It would be just as logical, or illogical, to assume that because alcohol induces a state of euphoria, schizophrenia is due to a deficiency of alcohol. Another source of misapprehension is the fact that the convulsion itself gives rise to severe though temporary dislocations of physiological equilibrium in general and of fluid balance in particular. During and immediately after convulsions the body loses a considerable amount of extracellular fluid, and this temporary dehydration is naturally followed by a reactionary phase of water retention. The body, in short, loses water during fits and recovers it in the intervals. But somehow this has been twisted round into the statement that the body retains extra fluid between convulsions and discharges it during the fit. Epilepsy is therefore due, argues the enthusiast, to retention of water. When he is reminded that
The
489
convulsions are not a symptom of oedema, he shifts ground and postulates a local oedema of the brain due to obstruction of venous return. Counter this with the fact that the tension of cerebrospinal fluid is normal in epilepsy and he falls back on local shifts of water between the neurone and its environment. Surrounded thus by the cell membrane he is safe from assault. Nevertheless the onus of proving his hypothesis rests on him ; and in point of fact no single metabolic aberration has yet been demonstrated to precede the epileptic fit. The normal activities of the neurone are responsive to changes in its environment, and it is therefore no cause for surprise that its pathological activities can be similarly modified. But while informed opinion may remain unmoved by inconclusive evidence, it must always leave some impression on the general reader who has neither time nor training to assess it at its true worth. In consequence much of the time and resources of medical research workers must be spent in disproving " theories " which ought never to have been propounded. A recent publication by Dr. H. S. TEGLBJAERG1 is a case in point. Dr. TEGLBJAERG records the results of exhaustive investigation into all aspects of the relation of water metabolism to epilepsy, during the course of which he has carefully tested the data and criticised the conclusions of his predecessors. The net result of a great deal of expenditure of time, money, and labour is that there is no positive evidence to incriminate water metabolism in the aetiology of epilepsy, but that forcing of fluids, associated with injection of pitressin, may be useful in diagnosing the disease. Such negative inquiries seem inevitable, but one is left with a feeling of regret that the resources at Dr. TEGLBJAERG’S command have had to be used to such small gain.
NON-SPECIFIC PROTEIN THERAPY ABOUT twenty years ago it was shown that the course of typhoid fever is often favourably influenced by intravenous injections of typhoid vaccine.2 It was soon found that similar results could be got with Bacillus coli vaccine3 or albumose,4and non-specific protein therapy dates from these observations. A great variety of proteins has since been used to treat an even greater variety of conditions, both acute and chronic. The American Council on Pharmacy and Chemistry, believing that there are many proprietary preparations of this type of unproved value, and that the indications for the use of non-
specific protein therapy are not widely appreciated,
has recently authorised the publication of two informative articles on the subject. In the first of these CECIL5 provides a critical review of the whole field. The three proteins most often used in the United States are typhoid vaccine, 1 Investigations on Epilepsy and Water Metabolism. By H. Stubbe Teglbjaerg. Acta Psych. et Neurol. Suppl. xi., 1936. 2 Kraus, R., and Mazza, S.: Deut. med. Woch., 1914, xl., 1556. 3 Kraus, R., Penna, J., and Bonorino, C. L.: Wien. klin. Woch., 1917, xxx., 869. 4 Lüdke, H.: Münch. med. Woch., 1915, lxii., 321. 5 Cecil, R. L.: Jour. Amer. Med. Assoc., 1935, cv., 1846.
THE LANCET LONDON: SATURDAY. FEBRUARY 29, 1936
WATER METABOLISM IN EPILEPSY DURING the past few years the field of epilepsy research has been inundated with water. flood reached its height a year or two ago, and, having damped the ardour of all but a few enthusiasts, has since been receding rapidly, so that it is now possible to take stock of the situation. Apart from a few damp patches, the field seems remarkably unchanged. The idea that epilepsy might have something to do with water metabolism is not new. HIPPOCRATES is credited with the statement that " whoever is acquainted with such a change in men and can render a man humid and dry, hot or cold by regimen could also cure this disease-without minding purifications, spells and all other illiberal practices of a like kind." LENNox and CoBB have aptly paraphrased this as follows : " Whoever is acquainted with physiology and can render a man acidotic, dehydrated and fully oxygenated could also repress this disease, without minding purification of narcissistic personalities, ritualistic empirical diets and all other illiberal practices of a like kind." Both the original dictum and the paraphrase have been frequently repeated, in our own columns and elsewhere, and they stand repetition. But neither the Father of Medicine nor his interpreters would be pleased to see their words construed as meaning that epilepsy is due to waterlogging of the brain. It is true that modern research has confirmed the intuition of HIPPOCRATES in that it has shown that anything conducive to dehydration-be it starvation, a ketogenic diet, or drastic restriction of fluid intake-will often lessen the frequency of fits in the epileptic, and that on the other hand forcing of fluid will precipitate convulsions. But it is a perilous jump from these facts to the conclusion that epilepsy is an expression of disturbed water balance. It would be just as logical, or illogical, to assume that because alcohol induces a state of euphoria, schizophrenia is due to a deficiency of alcohol. Another source of misapprehension is the fact that the convulsion itself gives rise to severe though temporary dislocations of physiological equilibrium in general and of fluid balance in particular. During and immediately after convulsions the body loses a considerable amount of extracellular fluid, and this temporary dehydration is naturally followed by a reactionary phase of water retention. The body, in short, loses water during fits and recovers it in the intervals. But somehow this has been twisted round into the statement that the body retains extra fluid between convulsions and discharges it during the fit. Epilepsy is therefore due, argues the enthusiast, to retention of water. When he is reminded that
The
489
convulsions are not a symptom of oedema, he shifts ground and postulates a local oedema of the brain due to obstruction of venous return. Counter this with the fact that the tension of cerebrospinal fluid is normal in epilepsy and he falls back on local shifts of water between the neurone and its environment. Surrounded thus by the cell membrane he is safe from assault. Nevertheless the onus of proving his hypothesis rests on him ; and in point of fact no single metabolic aberration has yet been demonstrated to precede the epileptic fit. The normal activities of the neurone are responsive to changes in its environment, and it is therefore no cause for surprise that its pathological activities can be similarly modified. But while informed opinion may remain unmoved by inconclusive evidence, it must always leave some impression on the general reader who has neither time nor training to assess it at its true worth. In consequence much of the time and resources of medical research workers must be spent in disproving " theories " which ought never to have been propounded. A recent publication by Dr. H. S. TEGLBJAERG1 is a case in point. Dr. TEGLBJAERG records the results of exhaustive investigation into all aspects of the relation of water metabolism to epilepsy, during the course of which he has carefully tested the data and criticised the conclusions of his predecessors. The net result of a great deal of expenditure of time, money, and labour is that there is no positive evidence to incriminate water metabolism in the aetiology of epilepsy, but that forcing of fluids, associated with injection of pitressin, may be useful in diagnosing the disease. Such negative inquiries seem inevitable, but one is left with a feeling of regret that the resources at Dr. TEGLBJAERG’S command have had to be used to such small gain.
NON-SPECIFIC PROTEIN THERAPY ABOUT twenty years ago it was shown that the course of typhoid fever is often favourably influenced by intravenous injections of typhoid vaccine.2 It was soon found that similar results could be got with Bacillus coli vaccine3 or albumose,4and non-specific protein therapy dates from these observations. A great variety of proteins has since been used to treat an even greater variety of conditions, both acute and chronic. The American Council on Pharmacy and Chemistry, believing that there are many proprietary preparations of this type of unproved value, and that the indications for the use of non-
specific protein therapy are not widely appreciated,
has recently authorised the publication of two informative articles on the subject. In the first of these CECIL5 provides a critical review of the whole field. The three proteins most often used in the United States are typhoid vaccine, 1 Investigations on Epilepsy and Water Metabolism. By H. Stubbe Teglbjaerg. Acta Psych. et Neurol. Suppl. xi., 1936. 2 Kraus, R., and Mazza, S.: Deut. med. Woch., 1914, xl., 1556. 3 Kraus, R., Penna, J., and Bonorino, C. L.: Wien. klin. Woch., 1917, xxx., 869. 4 Lüdke, H.: Münch. med. Woch., 1915, lxii., 321. 5 Cecil, R. L.: Jour. Amer. Med. Assoc., 1935, cv., 1846.