What Comes After Dilantin?

It has been our understanding that the epileptic attack represents a discharge of energy, either because the individual is unable to tolerate much of an accumulation or because he stores up so much that an extraordinary outlet is necessary. In taking Dilantin successfully, the patient seems to reduce his excitability, and the effect is that of tolerating better the various stimuli he receives in daily life. But he is also blocking a means of discharge which he formerly had.

In the first case, he tends to numb his response to inner and outer irritations. To the extent that this regulates or “levels off” the curve of his dysrhythmia, it is an advantage. The unwelcome factor is a tendency to respond too slowly or too poorly to the ordinary demands of life. In that direction lies not merely a calmer mode of living, but also a lethargic effect, which would easily lead to deterioration.

In the second case, the individual might continue to build up tension, but he has also closed the door on his attacks as a form of relief. Some other neurotic or psychotic pattern of symptoms may have to substitute for the epileptic attack. Or, to use the previous metaphor, the tension may eventually crash the door down and open up the old way of discharge, by convulsions.

The point is that, once Dilantin has shown some degree of effectiveness, immediate attention should be given to the emotional living-habits of the patient. An attitude of “sitting on the status quo” is not satisfactory. The individual must be constantly developing interests comparable to his ability. Psychoanalysis has indicated that the healthful way of living is the flowing outward of libido, towards objects and into constructive activities. It is particularly important that the epileptic, with his pent-up energy, be allowed to find new channels of discharge. Otherwise, the great advantages of Dilantin will be nullified.

In such cases as we are familiar with, once the attacks have been stopped there has been a spontaneous