The man behind the syndrome: Argyll Robertson,Scotland's ambassador extraordinary in the realm of ophthalmology

Abstract

The aim of this study is to find out whether bromide was able to cause conversion of epilepsy to psychosis i.e., so‐called paradoxical normalization such as has been seen in treatment with modern antiepileptic drugs. Spontaneous conversion has been known for three hundred years. Locock introduced bromide in the treatment of epilepsy in 1857. Belgrave wrote in 1868 on its effect on epileptic attacks and concommitant insanity. In 1868 Holm observed reduction of the frequency of seizures at the same time as psychotic symptoms or just dysphoria. In 1875 Voisin described a dose‐dependent intoxication with psychosis and/or neurological signs. Stark in 1875 and Bannister in 1881 were the first to clearly describe the antagonism between epileptic seizures and psychotic symptoms, an antagonism or conversion described by many authors, both in cases with high and low dosage, and with and without intoxication. Thus, the title of this paper should be answered in the affirmative.

Bromide has been used as a sedative and has rarely caused intoxication. Thus the presence of epilepsy is not a condition for the development of bromide intoxication. A case with epilepsy and fatal massive bromide intoxication is reported. It is discussed whether the pathological findings give support to Wolf's hypothesis of latent epileptic activity in subcortical pathways during “normalization”;.