Seizure Disorder and its Homoeopathic Approach

Dr Heena Sayed
PG PART 1 YMTHMC

A seizure is a paroxysmal event due to abnormal excessive or synchronous neuronal activity in the brain.

The meaning of the term seizure needs to be carefully distinguished from that of epilepsy. Epilepsy describes a condition in which a person has recurrent seizures due to a chronic, underlying process.

A fundamental principle is that seizures may be either focal or generalized. Focal seizures originate within networks limited to one cerebral hemisphere (note that the term partial seizures is no longer used). Generalized seizures arise within and rapidly engage networks distributed across both cerebral hemispheres. Focal seizures are usually associated with structural abnormalities of the brain. In contrast, generalized seizures may result from cellular, biochemical, or structural abnormalities that have a more widespread distribution. 

Clinical Classification of seizures:

1. Generalized:
   Tonic-Clonic
   Tonic
   Atonic
   Absence(PetitMal)
   Myoclonic.
2. Focal(partial)
   This may be:
3. Without dyscognitive features
4. With dyscognitive features

This may again be

1. Motor
2. Somato-Sensory or special sensory (olfactory, visual)

• Autonomic (epigastric sensation)

1. Psychic symptoms (fear, deja vu)
2. Automatisms (smacking of lips etc).

1. Partial becoming generalized i.e. Clinical or EEG evidence of focal discharge before, during or after the generalized seizure.
2. Clinical recognition of a seizure: In a majority of situations the physician never has a chance to see a patient during the fit. In such situations the evidence given by the by-stander attendant is the only clue.
3. Make specific queries as follows:
   1. Did he fall and injure himself?
   2. Any tongue bite?
   3. Did he pass ;urine and wet his undergarment?
   4. Was he confused after the attack?
   5. Did the attack occur during sleep – if so, it almost definitely excludes hysterical causes. 

Differential Diagnosis of Seizures

Syncope: Vasovagal syncope, Cardiac arrhythmia, Valvular heart disease, Cardiac failure, Orthostatic hypotension

Psychological disorders: Psychogenic seizure,Hyperventilation,Panic attack

Metabolic disturbances: Alcoholic blackouts, Delirium tremens,Hypoglycemia,Hypoxia

Psychoactive drugs: (e.g.,hallucinogens)

Migraine:Confusional migraine,Basilar migraine

Transient ischemic attack (TIA):Basilar artery TIA

Sleep disorders:Narcolepsy/cataplexy,Benign sleep myoclonus

Movement disorders:Tics,Nonepileptic myoclonus,Paroxysmal choreoathetosis

Special considerations in children: Breath-holding spells, Migraine with recurrent abdominal pain and cyclic vomiting, Benign paroxysmal vertigo,Apnea,Night terrors, Sleepwalking 

Drugs and Other Substances That Can Cause Seizures

• Alkylating agents (e.g., busulfan,chlorambucil)
• Antimalarials (chloroquine,mefloquine)
• Antimicrobials/antiviral -lactam and related compounds,Quinolones,Acyclovir,Isoniazid,Ganciclovir
• Anesthetics and analgesics:Meperidine,Tramadol,Local anesthetics
• Dietary supplements: Ephedra (ma huang),Gingko
• Immunomodulatory drugs:Cyclosporine,OKT3 (monoclonal antibodies toT cells),Tacrolimus,Interferons
• Psychotropics: Antidepressants,Antipsychotics,Lithium
• Radiographic contrast agents:Theophylline
• Sedative-hypnotic drugwithdrawal:Alcohol,Barbiturates (short-acting),Benzodiazepines (short-acting)
• Drugs of abuse:Amphetamine,Cocaine,Phencyclidine,Methylphenidate
• Flumazenila  benzodiazepine-dependent patients

Causes of Seizures

Neonates (<1 month):

Perinatal hypoxia and ischemia, Intracranial hemorrhage and trauma, Acute CNS infection

Metabolic disturbances (hypoglycemia,hypo calcemia, hypomagnesemia, pyridoxinedeficiency),Drug withdrawal

Developmental disorders,Genetic disorders

Infants and children (>1 month and<12 years):

Febrile seizures, Genetic disorders (metabolic, degenerative, primary epilepsy syndromes), CNS infection

Developmental disorders,Trauma,Idiopathic

Adolescents (12–18 years):

Trauma, Genetic disorders,Infection

Older adults (>35 years):

Brain tumor, illicit drug use, Alzheimer’s disease and other degenerative CNS diseases,  Idiopathic

Young adults (18–35 years):

Trauma,Alcohol withdrawal,Illicit drug use, Brain tumor,Idiopathic,Cerebrovascular disease,Brain tumor, Alcohol withdrawal, Metabolic disorders (uremia, hepatic failure,electrolyte abnormalities, hypoglycemia, hyperglycemia)

STATUS EPILEPTICUS
Status epilepticus refers to continuous seizures or repetitive, discrete seizures with impaired consciousness in the interictal period. Status epilepticus has numerous subtypes, including generalized convulsive status epilepticus (GCSE) (e.g., persistent, generalized electrographic seizures, coma, and tonic-clonic movements), and nonconvulsive status epilepticus (e.g., persistent absence seizures or focal seizures, confusion or partially impaired consciousness, and minimal motor abnormalities). The duration of seizure activity sufficient to meet the definition of status epilepticus has traditionally been specified as 15–30 minutes.  For GCSE, this is typically when seizures last beyond 5 minutes.

GCSE is an emergency and must be treated immediately , since cardiorespiratory dysfunction, hyperthermia, and metabolic derangements can develop as a consequence of prolonged seizures, and these can lead to irreversible neuronal injury.

Diagnosis
In persons suffering from epilepsy, the brain waves, electrical activity in the part of the brain called the cerebral cortex, have a characteristically abnormal rhythm produced by excessive electrical discharges in the nerve cells. Because these wave patterns differ markedly according to their specific source, a recording of the brain waves, known as an electroencephalogram (EEG) is important in the diagnosis and study of the disorder. Diagnosis also requires a thorough medical history describing seizure characteristics and frequency.

Treatment
There is no cure for epilepsy in allopathy but symptoms of the disorder may be treated with drugs, surgery, or a special diet. Drug therapy is the most common treatment-seizures can be prevented or their frequency lessened in 80 to 85 percent of cases by drugs known as anticonvulsants or antiepileptics. Surgery is used when drug treatments fail and the brain tissue causing the seizures is confined to one area and can safely be removed. A special high-fat diet known as a ketogenic diet produces a chemical condition in the body called ketosis that helps prevent seizures in young children. Like any medical condition, epilepsy is affected by general health. Regular exercise, plenty of rest, and efforts to reduce stress can all have a positive effect on a person with a seizure disorder.

First aid for generalized seizures involves protecting the individual by clearing the area of sharp or hard objects, providing soft cushioning for the head, such as a pillow or folded jacket and, if necessary, turning the individual on the side to keep his or her airway clear. The individual having a seizure should not be restrained and the mouth should not be forced open-it is not true that a person having a seizure can swallow the tongue. If the individual having the seizure is known to have epilepsy or is wearing epilepsy identification jewelry, an ambulance should only be called if the seizure lasts longer than five minutes, another seizure closely follows the first, or the person cannot be awakened after the jerking movements subside.

Some Of The Acute Seizure Therapeutics Is Described As Follows:

Agaricus Muscaris.
Seizure caused due to bad effects of sexual excess, alcohol, debauch or suppressed excess. Twitching and trembling, jerking of the whole body with chore. Delirium with constant raving. Involuntary movements while awake, ceases during sleep. Chorea of single muscle with dancing of whole body. Great mental excitement with incoherent talks. Stumbles over objects.

Argentum nitricum:
The strong indications for Argentum-nit in epilepsy is that for days or hours before an attack the pupils are dilated. After the attack the patient is restless and has trembling of his hands. It is suitable in cases of epilepsy caused by fright or when they occur at the time of menstruation. Dr. Clarke states that this drug is called for in recent cases when the ailment is associated with digestive disorders and excessive flatulence. When belching is premonitory of fit Argentum-nit taken every half hour will prevent an attack. Additional leading symptoms are intense vertigo with uncoordinated movements, melancholy and timid disposition; averse to being alone, hurried in actions.

Artemisia vulgaris:
Artemisia vulgaris is another remedy which has been successfully used for epilepsy without aura , from fright or some violent mental emotion or after masturbation,after a blow on head, where the attacks occur in rapid succession, and also in petit mal, where the patient is unconscious only for a few seconds and then resumes his occupation as if nothing had happened. Attack is accomapanied by profuse sweating having peculiar cadaveric or garlic like odour.right side convulsed and left paralysed.

Belladonna :
Convulsions begin in the upper extremities and extend to the face, eyes and mouth; fits of short duration several times during the day and passing off suddenly. Moans constantly, subjective visual illusions and Hallucinations, Delirium, sees frightful images, furious; rages, bites, strikes, acuteness of all senses. Perversity wit tears

Bufo-rana:
The cause in bufo is masturbation or self abuse. Aura begins in sexual organ r from solar plexus. The attack usually occurs at night or during coition or at time of menses. The patient may or may not awake during the attack but when he does wake he will have violent headache. Convulsion usually followed by profound sleep.

The epileptic seizure and the status epilepticus give the clearest correspondence to the Bufo range of action. Again epilepsy is often found among the effects of self-abuse in young” (Clarke) Dr. Alfons Genkers considers Bufo as the number one remedy in epilepsy.

Calcarea-carb: The epilepsy of Calcarea has an aura spreading up from the solar plexus in which case the convulsions come on immediately: or it may be like a mouse running up the arm. Common causes in fright, suppressed eruptions, discharges and sexual excesses (Dr. Clarke). Dr. Farrington says that Calcarea-carb seems to be able to cure epilepsy, not so much the paroxysms themselves but to aid in the change of the constitution by which this dreadful disease may be cured. It follows Sulphur well. One is apt to think of Sulphur for the sensation of a mouse creeping up the arm, same symptom in both Sulphur and Calcarea and the causes are indicated above are also the same for both. Calcarea is particularly indicated if Sulphur does not cure or if the pupils do not dilate after the use of Sulphur. 

Causticum:
Causticum is useful in Petit mal, also when the patient falls while walking in the open air, but soon recovers. It is said to be useful when the attacks occur at new moon. Contaction of flexor tendon. It menstrual epilepsy and that occurring at puberty Causticum is the remedy.

Cenanthe crocata:
Perhaps no remedy in the materia medica more closely pictures epilepsy than Œnanthe. The reliable and practical symptoms calling for its use may be summed up as follows: Sudden and complete loss of consciousness; swollen livid face; frothing at the mouth; dilated or irregular pupils; convulsions with locked jaws and cold exremities. 

Cicuta-virosa:
This remedy produces congestion at the base of the brain and in the medulla oblongata. At first, the patient is rigid with fixed staring eyes, bluish face, frothing at the mouth and unconsciousness. Next there are series of shocks from the head through the body. The jaws are locked and the patient bites the tongue. These spasms are followed by profound exhaustion. There is frightful distortion of limbs and the whole body goes into odd shapes. Head is turned backwards and back is bent as in opisthotonos.

Delusion, thinks he is a child again Children have convulsions from worms. Convulsions extend from to circumference, from above downwards and hence it is opposite of Cuprum

Cuprum-met:
Convulsion here is caused by a blow on head or from getting wet. Aura begins in lower extremities and proceeds upwards. (from above down wards is citcuta ) In epilepsy calling for Cuprum we have contractions and jerking of the knees, fingers and toes. He falls with a shriek and during the attack passes urine and faeces. It is indicated when it begins with violent constriction in lower part of the chest or with contractions in the fingers that spread all over the body to all the muscles (Dr. Kent). The interictal phase is restless too. The attack usually occurs during the first part of sleep. Again Dr. Kent says “It is pre eminently a convulsive remedy. The convulsive tendency associated with almost every complaint that Cuprum creates and cures. It has convulsions in every degree of violence from the mere twitching of little muscles and of single muscles to convulsions of all the muscles. The earliest threatening are drawings in the fingers clenching of the thumbs or twitching of the muscles. Tonic contractions, the limbs being drawn up with great violence and it seems as if the frame would be torn to pieces by the violent contractions of the muscles everywhere”. Mostly aggravated at night, during new moon and full moon.

Helleborus:
During convulsion there is automatic motion of one arm and one leg. There is extreme coldness of the body, except in head or occiput which may be hot. The patient greedily swallows cold water; he bites the spoon, still remaining unconscious. The mouth is in chewing motion, corners of mouth sore,crackes and nostrils dirty. The patient bores his head into pillow and moves his head from side to side, beats the head with hand. The patient also constantly picks his lips, clothes or bores the nose with fingers. Convulsion is followed by stupefying headache. Forehead has wrinkled folds covered with sweat. Dull pain in occiput. Headache may be followed by vomiting.

Nux vomica: The characterizing feature of epilepsy is ‘Convulsions with conciusness’.Spasms with titanic Rigiity of nearly all muscles of the body, with interruptions of few minutes, during which the muscles becomes relaxed,pulse becomes soft and patient regain consciousness and speech, the spasm gets again renewed by slightest touch. Convulsions usually begins with slightest twitching of muscles of lower extremities and then of entire body to obtain an opisthotonus position with throwing back of head ,red face and closed eyes or else protruding though in some the body is drawn sideways. The body temperature doesn’t rises in nux as in cases as tetanus.

Patient are observed screaming ‘Hold me’ during convulsions.(Dr Clarke)

Stramonium: It is an important remedy in cases of epilepsy in children. There is convulsions with consciousness.(nux vom).They frequently wake up during night, screaming, terrified and do not recognize anyone around them (KR 12 :clinging child awakens terrified, knows no one, screams and clings to those near). Graceful rhythmic movement of upper extremities or upper part of the body. Trembling, twitching and jerking movement of single muscle or group of muscles. Spasmodic contraction of throat.

There is fear of dark. At night they want to sleep with their parents like Phos and Puls (KR), Darkness agg; KR 43. Fear of dark: KR 62, light desire for). They would like to have a small light in their room. They are afraid of water; Hydrophobia. Especially afraid when their head gets wet; may not want water on the face; may not allow washing their hair. (KR 52 Hydrophobia; KR 48 fear water of). They are afraid of mirrors and light that shines in the mirror. At night they become panicky even by seeing their own reflections in the mirror. (KR 79 shining objects agg KR 30 Delusion objects, bright from KR 46 fear mirrors in room). One can find a lot of violence in children (KR 91 violent; KR 71 – rage, violent).

Whenever you find the combination of epilepsy, violence and fear of darkness consider Stramonium

Viratrum viride:
The main etiopathogenicity is congestion here. Intense congestion, almost apoplectic . Hot Head, Blood shot eyes, boted livid face. Hippocratic face. Head retracted pupils dilated, double vision. Convulsive twitching of facial muscles. Meningitis.