Duchenne Muscular Dystrophy and Homoeopathic management

Dr Swasthik Jain

ABSTRACT
Diseases of muscle constitute about 10 per cent of all neurological problems and hence are important for the clinicians. Muscles can be affected by a variety of causes, genetic and acquired. Over the past few years, the fields of genetics and immunocytochemistry have expanded exponentially and this had led to a wealth of understanding of the inherited myopathies. The pathophysiological mechanisms of the disease processes are being elucidated at the molecular level and considering the rapidity of such developments, corrective therapy for these disorders appears to be a possibility. Management of the cases can be done using homoeopathic medicines.

KEY WORDS : Duchenne Muscular Dystrophy, Creatinine kinase, Calf Hypertrophy.

INTRODUCTION
Duchenne muscular dystrophy (DMD), an X-linked disorder, is the most common muscular dystrophy in children, presenting in early childhood and characterized by proximal muscle weakness and calf hypertrophy in affected boys. Patients usually become wheelchair-bound by 12 years and die in their late teens to early twenties. Advances in the management of this disorder with supportive therapy, corticosteroids, as well as novel therapies hope to change the outcomes of this disorder.^[1]

PATHOGENESIS AND GENETICS
DMD is caused by mutations in the DMD gene, one of the largest known genes in humans, spanning 2.3 megabases and accounting for 0.1% of the total human genome.

The precise mechanism of how dystrophin deficiency leads to degeneration of muscle fibers remains unclear. Absence of dystrophin at the plasma membrane leads to delocalisation of dystrophin-associated proteins from the membrane, disruption of the cytoskeleton with resultant membrane instability and increased susceptibility to mechanical stress. In addition, altered membrane permeability and abnormal calcium homeostasis are thought to play a role, with increased cytosolic calcium concentration leading to activation of proteases such as calpains. The absence of nitric oxide synthase, delocalized from the subsarcolemmal membrane, may contribute to damage, but is not thought to directly cause dystrophic features.^[1]

CLINICAL FEATURES ^[3]

• The incidence of DMD is approximately 1 in 3500 live male births.
• Motor delay or abnormal gait are the most frequent presenting complaint.
• Initial symptoms are repeated falls and weakness while climbing stairs and getting up from ground.
• Fatigue
• Gowers maneuver seen in children.
• Hypertrophy of calf muscle.
• A proportion of patient have mental sub normality.

COMPLICATIONS ^[1][3]

• Duchenne muscular dystrophy is a rare progressive disease which eventually affects all voluntary muscle and involves the heart and breathing muscles in later stages.
• Life expectancy is estimated to be around 25-30 years but this varies.
• The most common direct cause of death in people with DMD is respiratory failure.
• The next leading cause of death is cardiac related conditions such as heart failure brought on by dilated cardiomyopathy.

DIAGNOSIS ^[1][4]  

1. DNA Test : DNA Testing (blood test) and analysis can usually identify the specific type of mutation of the exon or exons that are affected.

2. Muscle Biopsy : If DNA test fails to find the mutation, a muscle biopsy test may be performed.

3. Creatine Kinase : The level of CPK-MM in the bloodstream are extremely high

4. Electromyography : It shows the weakness caused by destruction of muscle tissue, rather than by damage to nerves.

5. Prenatal Test : It is considered when the mother is a known or suspected carrier.

REVIEW OF ARTICLE
A case report on clinically improved case of Duchenne muscular dystrophy in an 8 year old boy done by Dr Yaseen G, saheen welfare foundation, Department of medicine Lahore, Pakistan.

Based on the totality of case child was prescribed individualized homoeopathic medicine for 1 month initially and asked for follow-up onwards. On the second visit his health condition was much better as he could stand from sitting position with less difficulty and his wadding gait improved a bit after regular administration of homoeopathic medicine for 6 months he improved clinically.^[4]

INDICATIONS OF SOME HOMOEOPATHIC MEDICINES ^[5][6]

 CAUSTICUM
Numbness. Paralysis of single parts. Dull, tearing pain in hands and arms. Heaviness and weakness. Unsteadiness of muscles of forearm and hand. Numbness; loss of sensation in hands. Weak ankles. Cannot walk without suffering. Slow in learning to walk. Unsteady walking and easily falling. Restless legs at night.

PLUMBUM METALLICUM
Cannot raise or lift anything with the hand. Extension is difficult. Pains in muscles of thighs; come in paroxysms. Cramps in calves. Feet swollen. Pain in atrophied limbs alternates with colic. Loss of patellar reflex. Hands and feet cold.

CURARE
Muscular weakness without impairing sensation and consciousness. Paralysis of respiratory muscles. Reflex action diminished. Catalepsy. Nervous debility. Trismus. Glycosuria with motor paralysis.

LATHYRUS SATIVA
Tremulous, tottering gait. Knees knock against each other when walking. Cannot extend or cross legs when sitting. Myelitis, with marked spastic symptoms. Gluteal muscles and lower limbs emaciated. Legs blue; swollen, if hanging down. Stiffness and lameness of ankles and knees, toe do not leave the floor, heels do not touch floor, Muscles of calves very tense. Patient sits bent forward, straightens with difficulty.

MAGNESIUM CARBONICUM
Tearing in shoulders as if dislocated. Right shoulder painful, cannot raise it (Sang). Whole body feels tired and painful, especially legs and feet. Sense of numbness; nerve prostration.

PICRICUM ACIDUM
Weakness from a short walk, with excessive heaviness. Heaviness of arms and legs on exertion, legs weak and heavy all the time.

Weakness of limbs on ascending stairs. Numbness and crawling in legs with trembling and pricking as from needles. Twitching on back of  hip at 9 p.m. Hips and legs heavy all day. Knees weak.

KALIUM CARBONICUM
Backs and legs give out. Uneasiness heaviness, and tearing in limbs and jerking. Limbs sensitive to pressure. Paralysis of old people. Limbs go to sleep easily.

GELSEMIUM
Loss of power of muscular control. Cramp in muscles of forearm. Professional neuroses. Writer’s cramp. Excessive trembling and weakness of all limbs. Fatigue after slight exercise.

REPRESENTATION OF DMD IN REPERTORIES

1.HOMOEOPATHIC MEDICAL REPERTORY ^[7]

• MUSCLE- Muscular, dystrophy – caust.,lath.,plb.
• MUSCLE – Weak, muscle – agar., alumn., BAR-C, calc, CAUST, ferr, GELS, PIC-AC., PLB.,verat., zinc

Weak, Progressive – acon., ars, dig., phos.,plb., verat

Weak, walking,worse,feel as if giving away – arg , cupr–m.,ferr., guare., HYDR.,kali-br., mag-c

2.BOGER BOENNINGHAUSEN’S CHARACTERISTICS AND REPERTORY ^[8]

• LOWER EXTREMITY – Weak and weary muscle : Agar., alu., amb.,Am-c, Ars.,Bell., CALC-C, Hell.,phos, pho-ac.,zin.
• SENSATION AND COMPLAINTS IN GENERAL – Relaxed,flabby,weak: Agar., Alu.,CALC-C., mag-c.,Pho.,plb.,Ver-a

3.REPERTORY OF HOMOEOPATHIC MATERIA MEDICA-J.T KENT

• EXTREMITIES – AWKWARDNESS ,lowerlimb. Stumbling when walking: Agar.,calc.,Caust.,gels.,mag-c.,ph–ac.,phos.,verat.

CONCLUSION
Duchenne Muscular Dystrophy is an X-linked disorder most commonly seen in males in their early childhood. Genetic mutation is the main cause of the disease. The only available option for the condition is Corticosteroid, which is not as a curative medicine but to prolong the life. Prolong intake of corticosteroids has it’s own side-effects over the body. There are some studies conducted in homoeopathy for the management of DMD. Individualized homoeopathic medicines are used for the treatment and it showed significant improvement in the cases. So Homoeopathic medicines are found effective in the treatment of Duchenne Muscular Dystrophy

REFERENCES  

1. Kornberg A, You E. Duchenne Muscular Dystrophy, Neurology India. 2008;56(3):236
2. Dan longo, Anthony fauci, dennis kasper, Stephen hauser, j jameson and joseph loscalzo. Harrison’s manual of medicine, 19^th edition 2012; 2707-2708
3. Munjal Y.P API Textbook of Medicine, 10^th Edition 2015; 2095-2104
4. Yassen G. Duchenne Muscular Dystrophy Improved Clinically by Homeopathy: A Case Report. Ann Clin Med Case Rep. 2021; V6(13): 1-3.
5. William Boericke’s New Manual of Homoeopathic Materia Medica with Repertory. Revised and augmented 3e:B Jain publishers, New Delhi:2017.
6. Clarke J H.A Dictionary of Practical Materia Medica.Jain publishers, New Delhi,1982.
7. Murphy R.Homoeopathic Medical Repertory. Revised 3e:B Jain publishers, New Delhi:2009;1745,1750.
8. Boger C M.Boger Boenninghausen’s Characteristics and Repertory. B Jain publishers, New Delhi.873,910.
9. Kent J T.Repertory of the Homoeopathic Materia Medica.6 American edition:IBPP,New Delhi:2016;953.

Dr Swasthik Jain
PG Scholar Department of Practice of Medicine
Under the Guidance of  Dr Praveen Kumar P.D (HOD of Dept of Medicine)
Government Homoeopathic Medical College and Hospital
Dr.Siddhaiah Puranik Road,Basaveshwar Nagar,Bengaluru,560079