The Effects of Sustained Pituitary Antidiuresis and Forced Water Drinking in Epileptic Children. A Diagnostic and Etiologic Study 12

Abstract

In the course of work already reported (1) (2) on the relationship of water balance to the occurrence of convulsions in severely epileptic children, it was found that seizures, after having been brought under control by the production of a deficit in the body water, could be made to recur practically at will by the rapid reestablishment of a positive water balance with pituitary antidiuresis. The investigation reported in the present paper was undertaken with the purpose of further elucidating the mechanism of this reaction, which appeared to us to open a new avenue of approach to the complex problem of etiology in epilepsy.In order to avoid misinterpretations based upon the spontaneous occurrence of seizures, patients were selected who were known to have convulsions infrequently but with a fair degree of regularity. It was believed that any fundamental difference that might be found between the response of the normal subject to an artificially induced disturbance in the body fluid relationships and that of the epileptic patient during his usual period of freedom from seizures, might furnish valuable information regarding the underlying physicochemical pathology in epilepsy. The possibility of utilizing the observed reaction of the severe epileptic to an enforced positive water balance as a diagnostic procedure in mild or obscure cases also occurred to us early in the study.

Water intoxication in epileptic patients receiving carbamazepine.

“…However, the relationship between epilepsy and water balance appears established (McQuarrie, 1929). Fluid restriction has been successfully employed in the treatment of epilepsy (Stubbe-Teglbjaerg, 1936), whereas forced water intake has been used as a diagnostic test to produce seizures (McQuarrie and Peeler, 1931). This might have been responsible for the prolonged fit in one of our patients who developed hyponatraemia after the water load test.…”

Manifestations of Suprarenal Insufficiency Occurring With Pituitary Tumours

“…Epilepsy is an uncommon accompaniment of a pituitary chromophobe adenoma but when it forms a troublesome feature of the post-operative period it is worth considering whether water intoxication could be contributing to the difficulties of control of the epilepsy. It is possible to say this because induced water retention is one of the means whereby a potentially epileptic lesion may be provoked into a discharge (McQuarrie and Peeler, 1931). Thus, if in an epileptic patient who may have secondary suprarenal failure, the metabolism of water proves to be abnormal but can be corrected by cortisone, then cortisone therapy must be included among the measures designed to control the epilepsy.…”

“…has been shown to be misleading. The intravenous Thorn test (Renold, Jenkins, Forsham, and Thorn, 1952) has not so far been employed. Table III lists the results of some of the biochemical studies performed.…”

The role of neurosteroids in the pathophysiology and treatment of catamenial epilepsy

“…Catamenial epilepsy, in many cases, is assumed to be an acquired disorder and currently there is no clear evidence of genetic components. A variety of mechanisms such as fluctuations in antiepileptic drug levels, changes in water and electrolyte balance, and physiological variation in ovarian hormone secretion have been proposed as causes for catamenial epilepsy (McQuarrie and Peeler, 1931; Ansell and Clarke, 1956; Shavit et al, 1984; Rosciszewska et al, 1986; Kumar et al, 1988; Narbone et al, 1990; Herzog, 1991; Herkes et al, 1993; Rodriguez-Macias, 1996; Harden et al, 1999; Tuveri et al, 2008). Overall, cyclical changes in the circulating levels of estrogens and progesterone are now widely accepted to play a central role in the development of this condition (Fig.…”