Dr Ayfoona Rahiman PS
Abstract
Cerebral palsy (CP) is a group of movement disorders that appear in early childhood. Signs and symptoms vary among people and over time, but include poor coordination, stiff muscles, weak muscles, and tremors .There may be problems with sensation, vision, hearing, and speaking. Often, babies with cerebral palsy do not roll over, sit, crawl or walk as early as other children of their age. Other symptoms include seizures and problems with thinking or reasoning, which each occur in about one-third of people with CP. While symptoms may get more noticeable over the first few years of life, underlying problems do not worsen over time.
This group of patients will be unable to live independently during adulthood and need ongoing long term care .here we are discussing a case which has got improvement in quality of life and motor activities with the help of Antimonium tart 1m.
Key words : homoeopathy, cerebral palsy , Antimonium tart
INTRODUCTION
Cerebral palsy can result from brain injury occurring during the prenatal, perinatal, or postnatal periods because brain development continues during the first two years of life.[1] Patient may be classified according to the type of motor abnormality as spastic, dyskinetic (dystonic/athetoid), ataxic or hypotonic. The clinical picture is rarely clear cut. Patients are sub classified according to distribution of motor abnormality- in diplegia (legs are involved more than the arms), in quadriplegia (all four limbs are affected), in hemiplegia- one side of body is involved. It is important to use this classification for research and management because different types of Cerebral Palsy tend to have distinct causes, different associated deficits and different prognosis. The prognosis is best in hemiplegia and worst for quadriplegia. Survival rate have been about 90% in all types.[2] Spastic quadriplegia/ quadriparesis is the most severe form of cerebral palsy and is often associated with moderate-to-severe intellectual disability and it is caused by widespread damage to the brain or significant brain malformations.1 Population-based studies from around the world report that the prevalence estimates of CP range from 1.5 to more than 4 per 1,000 live births or children of a defined age range. The overall birth prevalence of CP is approximately 2 per 1,000 live births.[3] Delivering medical care to these individuals poses several problems, including practical issues such as consideration of capacity and consent to treatment. These individuals usually require a complex care package involving many members of the multidisciplinary team.[4]
Effective and easily implemented increased levels of physiotherapy/ occupational therapy may contribute to increased ability in function in a child with cerebral palsy. Family-centered rehabilitation therapies were positively associated with greater outcome but the amount of rehabilitation therapy was not related to developmental outcomes. [5-6] This group of patients will be unable to live independently during adulthood and need ongoing long-term care.
Here we are discussing a case which got marked improvement in quality of life and motor activities. This case report is an effort to show the role of homoeopathic medicine in the management of Cerebral Palsy.
CASE HISTORY
An 7 months old boy reported to the OPD on with the diagnosis of spastic Quadriparesis Cerebral Palsy,he presented with Complaints of delayed milestones, spasms and vomiting.
HISTORY OF CHIEF COMPLAINT
Mother narrated the complaints. child has delayed milestones. including neck holding, no eye to eye contact.( but baby rolls over,) also baby has vomiting after every feed, which is gradual in onset. initially the vomiting was not as frequent as it is now . Quantity was half of the feed. Now the character of vomiting changed and frequency increased. According to mother the vomiting increased due to weaning. Character is undigested food particles. And he vomits soon after every feed. The complaint spasm is present since birth ,baby was hospitalized soon after birth as he didn’t cry immediately. Initially seizures was not generalized it was only pertaining to upper extremity ,now baby gets on and off episode of spasms in arms and fingers .frequency is on every day
Presently baby is on lactogen. initially he tried to suck mothers milk but mother doesn’t have enough supply,so they switched to palada feeding. Mother also added that when ever they try to feed the baby he cries and shrieks in loud noise and ends up with cyanosis
PAST HISTORY
History of sepsis soon after birth was in NICU For 15 days
TREATMENT HISTORY – taken allopathic medication and hospitalized for sepsis
No surgical history
ALLERGIC HISTORY – not allergic to dust drug and diet.
BIRTH AND DEVELOPMENTAL HISTORY
Born at full term.
2.98 kgs, HC-35 cms, Length – 49 cms.
Did not cry immediately after birth, Was resuscitated and administered oxygen,cried after bag and mask,presented with RDS & shifted on to mechanical ventilation for 15 days &and baby was culture positive sepsis treared with antibiotics for 21 days
Baby was cyanosed, no spontaneous breathing, Poor perfusion and Low pulse volume.
Breast feeding started immediately and continued for 4 month but baby had no difficulty in suckling, later mother couldn’t feed due to less supply and switched to palada feeding
Perinatal hypoxia
ANC- During pregnancy no problems.
At labor- No problem ,DELAYED LABOR,DOCTOR DIDN’T COME ON TIME,MECONIUM ASPIRATION
LSCS was done
PERSONAL HISTORY
- Respiratory:
SYSTEMIC EXAMINATION:- no abnormality
Palpation- trachea centrally placed.
Percussion- resonant
Auscultation- Normal vesicular breath sound ,No added sound
Abdomen:Inspection– no distention
palpation– no rigidity, no tenderness, no organomegaly.
Percussion– tymp
SYSTEMIC EXAMINATION
- CNS – higher mental function : couldn’t elicit
- Cranial nerves : couldn’t elicit
- Motor system: bulk : normal
- Tone : hypotonia in upper extremity
- Power : normal in UE
- DTR: Exaggerated in UL
- No abnormal movements
- Sensory system: pain : normal
- Incordination : couldn’t elicit
Homoeopathic Treatment:
Considering the presenting totality Antimonium tart1M weekly one dose was prescribed and advised to report after one month.
Based on the repertorization and totality Antimonium tart and calc phosp was the indicated remedy
1ST PRESCRIPTION: Antimonium tartaricum
| Table-1: Time line and Follow up: Date | Follow Up | Medicine |
| 7/06/2021 | General improvement. Nodding of head reduced, spasticity persists as same. | CALCAREA PHOS 1M/1D weekly for 1 month |
| 11/08/2021 | Vomiting and regurgitation persist
Head control 30% attaines |
Placebo |
| 9/10/2021 | Fever, cough and coryza, bad breath, reduced appetite and thirst | Placebo
|
| 13/11/2021 | No attack of fever since last 1 month, fear of noises persists otherwise general improvement, flexibility of joints improving,.
Social smile present Responses to question by making noises Vomiting better |
Placebo |
| 11/12/2021 | Appetite improved, weight loss and vomiting | CALCAREA PHOS 1M/1D weekly for 1 month |
| 11/01/2022 | Vomiting better
Head control :60% attained |
placebo |
Result and Discussion
Cerebral palsy is a very important social and economic problem, since the affected children are co-dependent. This group of patients will be unable to live independently during adulthood and need ongoing long-term care.[7] Providing the quality life to the child is a difficult task but it is like silver lining to the dark cloud.
Initially, a comprehensive evaluation regarding etiopathogenesis, clinical features and investigations was done that started from a thorough medical history of child together with a complete physical examination. It was observed that the intervention using CALCAREA PHOSPHORICA resulted in gains on motor performance and functional balance in a child with CP.
Limitation of Study: The main limitations are related to the fact that this is a study of only one patient. So more controlled trials are needed in this area to prove effect of Homoeopathy in cerebral palsy.
Patient consent: Informed Consent has been taken form patients mother for treatment aswell as for publication of this case study.
Bibliography
- https://www.ninds.nih.gov/disorders/patient-caregiver-education/hope-through-research/cerebral-palsy-hope-through-research
- Warrel D, Cox MT, Firth DJ, Benz J E. Oxford textbook of medicine 4(3).
- Rana M, Upadhyay J, Rana, Durgapal s et al. A systematic review on etiology, epidemiology, and treatment of cerebral palsy. Uttarakhand, India, 2017,7(4):76-83
- Ralston Penmanian, Strachan Mark, Hobson R. Davidson’s principles and practice of medicine., ed elsevier, churchill Livingston, 23rd edition 2018 p-223
- Mulligan H, Wilmshurst E. Physiotherapy assessment and treatment for an ambulant child with cerebral palsy after botox a to the lower limbs: a case report. Pediatr phys ther. 2006 spring; 18(1):39-48.
- Mccoy SW, et al. Physical, occupational, and speech therapy for children with cerebral palsy. Dev med child neurol. 2020 jan;62(1):140-146.
Dr Ayfoona Rahiman PS
ayfubhms@gmail.com
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