Clinical Cases

A Case of Asperger’s Syndrome

Homeopath Petr Zacharias presents this case of Aserger’s syndrome with insights into his decision making at each step.

First visit: January 13, 2013

A boy (age 3.5 years) has been diagnosed with Asperger’s syndrome. EEG examination revealed a non-functional left cerebral hemisphere. He was carried to term and the birth was spontaneous, physiological and without complications. When he was 4 weeks old, he got his first coryza from which he has never recovered. He would be healthy for 2 – 3 days and then the coryza would come back. When he was 8 months old, he had a rotavirus infection with a fever between 38 – 38.5°C. Since then, he has never had any fever (not even low grade). He gets ill once a month now, regardless of the season. It is usually a coryza with an obstructed nose or laryngitis, but he never has fevers.

Such episodes used to last 14 days and now it is about 7 – 10 days. The course of his acute diseases has changed. Because he gets ill once a month throughout the whole year, regardless of the season, and the illness influences his general development, he suffers from a significant delay in development (walking and speech) (2). He is allergic to pollen and cats and he was diagnosed with an immune disorder. He has taken allopathic and homeopathic remedies for the allergy without apparent effect. The mother spontaneously reported that his most marked symptom is extreme motor restlessness (4). The boy is very hyperactive (3).

He started running very soon and he always fell a lot. The problem with bad coordination of motion has lasted until now (3), e.g., he falls down all of a sudden, hits himself against a door frame, drops things (1) etc. His ability to coordinate motion is very poor. For example, he is not able to eat on his own because his spoon misses the mouth or the food falls off the spoon. When he was younger, he was very irritable and weepy. He kept shrieking constantly and it was not possible to calm him down by any means. He is hyperactive and has an excess of energy (2). He has problems with comprehension and concentration (3). His sleep has been bad since he was born. He wakes 6 – 8 times per night and he is very restless in sleep (2/3).

He clings to his mother (3) to the extent that he does not bear being with anybody else, even with his father. He tends to have outbursts of anger during which he throws things (2). He is very chilly (3). He comes to his parent’s bedroom at night and wants to be covered (3). He is afraid of the dark (2) and noises (2/3). He loves red fruit and everything red, especially tomatoes (3), cherries, raspberries, and strawberries. He is generally much better from music. In the past, he received Tarentula hispanica from an experienced homeopath and he got much better after the remedy, mainly as far as his restlessness and sleep were concerned. However, 2 – 3 months after the administration of Tarentula, his state got worse again and a repetition of the remedy did not have any effect. Then he got Ignatia, which did not have any positive effect and that is why the homeopath brought the boy to our three-year intense training at the Prague College of Classical Homeopathy.

Depth of the disturbance

The disturbance of the central nervous system confirmed by EEG, which revealed a non-functional left hemisphere, is the source of most of the complaints in this case. The nervous system is the most important organ system in the body and it holds the highest position in the hierarchy of bodily organs. The disturbance of the CNS manifests itself on the emotional and mental level. From the medical point of view, the diagnosis is very serious.

Prognosis and level of health

The nature of the complaints, together with the fact that the center of gravity of the case is in the nervous system and on the emotional and mental level are unfavorable for the prognosis. The picture of symptoms does not clearly indicate any homeopathic remedy, and the child does not have acute diseases with high fevers. Both these factors also make the prognosis worse because they point to the fact that the organism is very weak. Although there is no evident occurrence in the case which could be directly connected to the origin of the complaints with certainty, it is highly probable that the rotavirus infection at eight months, which was his last infection with high fever, made the organism weaker and caused the drop down to a lower level of health.

In cases where the development of the complaints is preceded by some event (etiology), the prognosis is often better than in cases where the complaints develop spontaneously without an external provocation. In the same manner, it is unfavorable for the prognosis when we find complaints similar or the same as those from which the boy suffers in the family medical history. If the complaints develop spontaneously, without a triggering cause, the person must have an even stronger tendency (predisposition) to develop the given complaints.

The fact that the organism has not been able to produce high fever during acute states since the infection, is also in favor of this hypothesis, as well as is the fact that after the infection, the acute disease became milder and chronic complaints developed. On the other hand, we have no information suggesting that there have been any psychological or neurological ailments in the family medical history and that makes the prognosis better. The presence of a relatively high fever in the child’s medical history is also a positive factor and it means that before the disturbance fully developed, his level of health was relatively high (B6). Considering the absence of fevers in the last 1 – 2 years, the organism of this boy is currently at the level C7.

Analysis of the case

In each case without exception, it is necessary to ask oneself several questions first and find answers for them. Then we can proceed to a subsequent analysis. Any further steps would only be a choice of random symptoms and their entering into repertorizing software. Which questions are we talking about? First of all, we have to realize what to focus on in each individual case. We are not looking for separated symptoms, but for their individual pattern. The next question is what should ideally happen after the remedy and which direction the symptoms should take after the remedy. What makes the case the most individual? And what symptoms of this child are not common for other children with the same diagnosis? Which are the most peculiar to the case?

In this case, we need to focus primarily on the disturbance of the nervous system, so the ideal scenario is that the remedy will restore functionality of the non-functional hemisphere. This can only be attained if its dysfunction is not caused by mechanical (structural) damage of the brain and the disturbance is merely functional. After the remedy, apart from improvement of motion ability, we should also witness improvement in concentration, restlessness, sleep, and snoring. The organism should regain its former ability to produce acute diseases with high fevers as well. If a high fever occurs after a homeopathic remedy in such cases, it is nearly always followed by significant improvement of chronic problems.

In cases like this one in which we see a lot of symptoms, it is necessary to choose those that make the child individual and different from other children with the same diagnosis, in this case, Asperger’s syndrome. We call the symptoms that most of the children with Asperger’s syndrome have, pathognomonic symptoms (symptoms which are explicable with the given pathology and are common to all people with this diagnosis). These symptoms are the least important ones as far as the selection of a homeopathic remedy is concerned, because they do not represent the individuality of the case. It is not wise to include symptoms like fear of unfamiliar environment, introversion, desire to do things in a certain way, low ability to adapt to changes, aggressiveness, outbursts of anger, clinging to parents, bad comprehension and concentration, etc. in the analysis. Out of these, only the very intense ones constitute an exception. We have to include them in the analysis, despite their general character. They do not individualize the case by their nature, but they do it through their intensity.  On the other hand, there are symptoms unconnected with the Asperger’s syndrome, e.g., chilliness at night. We cannot say that everybody with the same diagnosis will have this symptom and neither can it be explained by the clinical diagnosis. These symptoms make the case the most individual.

Intense symptoms

  1. motor restlessness
  2. restless sleep
  3. fear of noises
  4. delayed development
  5. desire for tomatoes
  6. bad coordination of lower limbs
  7. awkward hands with dropping things
  8. excessive dependency on the mother
  9. difficult concentration
  10. difficult comprehension

Peculiar symptoms

  1. chilliness at night
  2. general amelioration from music
  3. he loves the color red and everything red

Repertorization in RADAR with Synthesis 9.1 repertory

The repertorization has been made using the technique of summary of symptoms with consideration of their intensity (For Radar users: Sum of symptoms and degrees – intensity is considered)

112344 MIND – RESTLESSNESS – children, in41
212343MIND – RESTLESSNESS – bed – tossing about in172
312343MIND – FEAR – noise, from41
412342GENERALS – DEVELOPMENT – arrested27
512342GENERALS – FOOD and DRINKS – tomatoes – desire3
612343EXTREMITIES – AWKWARDNESS – Lower limbs14
712341EXTREMITIES – AWKWARDNESS – Hands – drops things26
812343MIND – CLINGING – children; in – mother; child clings to the6
912342MIND – CONCENTRATION – difficult300
1012342MIND – DULLNESS – children, in30
1112343CHILL – CHILLINESS – night24
1212343MIND – MUSIC – amel.22
1312342MIND – COLORS – red – desire for5

 

caust.sil.acon.tarent.lyc.merc.bar-c.sulph.calc.bufo
52494646444140403938
13113121
22133221221
32111211
4121221
5
6321
712
811
93321323221
1012213321
1111
12311
131

Differential diagnosis

Causticum can be confirmed on the basis of problems with motor coordination and also delayed development which is a keynote of this remedy. Causticum is also stated in the corresponding rubric for restless sleep, but Causticum restlessness mainly concerns legs in the evening in bed. Strong motor restlessness is the leading symptom of the case and it is not a keynote of Causticum, and neither is the strong emotional dependency. It is interesting that Causticum can be found in the rubric “chilliness at night”, which is a relatively small rubric that corresponds with this peculiar symptom of the case. However, I was not able to confirm this symptom in any materia medica.

 Silicea children can have chronic coryza as this child and great problems with concentration, which is a keynote of this remedy. They often tend to be shy and can cling to their mother, but they are usually calm. The strong restlessness of the body is a contraindication for Silicea in this case. Although Silicea is a very chilly remedy, we cannot find it in the rubric “chilliness at night” and it therefore does not cover this peculiar symptom. However, the most important contraindication for Silicea is the mental picture of the child, which is absolutely opposite to Silicea. The child is very hyperactive, restless and angry, whereas Silicea children are calm, easy to handle, and mild.

Aconitum comes up very high in the repertorization, especially because of its strong restlessness, which is its keynote. Aconitum belongs among the most restless remedies in the whole materia medica. However, Aconitum exhibits restlessness mainly during anxiety, whereas this boy has excessive energy, so it is physical restlessness, which is certainly not typical for Aconitum. We do not see any other confirmatory symptoms of Aconitum in this child and the remedy does not cover the delayed development and problems with coordination. Aconitum is listed in the rubric “chilliness at night”, but this symptom cannot be confirmed in the materia medica.      

Tarentula hispanica covers the case the best so far because physical restlessness is one of its main keynotes. Tarentula also covers the peculiar symptoms of the case, like the fascination with red objects and general amelioration from music very well. In this respect, it aspires to become the simillimum. However, this remedy does not cover the delayed development and problems with coordination. Although these complaints are explicable by the diagnosis and they are therefore common symptoms for children with Asperger’s syndrome, they are very intense in this case and it would be ideal to find a remedy, which covers not only peculiarities of the case but also the main complaints. The fact that Tarentula provided significant general amelioration in the past also confirms that it is very close to this case. However, the fact that the repetition did not have an effect despite the symptoms being the same, shows that it was only a partially similar remedy and not the simillimum.

Lycopodium is present in the rubrics we used for the repertorization, but none of the symptoms is its keynote, except the difficult concentration, which is connected to the diagnosis and it therefore belongs to common symptoms.

Mercurius solubilis is listed in the rubric for restlessness in the third degree. However, children who need this remedy are, on the contrary, very precocious in their development, whereas this boy’s development is delayed.

Baryta carbonica is a possibility especially because of the delayed development. However, Baryta carbonica lacks the leading symptom of the case – the strong physical restlessness. A remedy, which can be considered in connection with Baryta carbonica is Baryta iodata. This remedy is restless and delayed development is characteristic of it. However, Baryta iodata is a very warm remedy, whereas this child is chilly, especially at night.

Sulphur and Calcarea carbonica come up high in most repertorizations and that is why it is utterly important for their prescription to check presence of their keynotes in a given case. None of the symptoms of this boy are keynotes of Sulphur or Calcarea carbonica.

Bufo rana is an interesting remedy for this case, especially because of its delayed development. It covers the restlessness, although it is not a keynote of this remedy. Bufo also has a strong affinity to the nervous system and its psychological picture partially fits this case, as far as the anger is concerned. However, problems with coordination are not characteristic of this remedy. Bufo is neither listed in the rubric “chilliness at night” and does not cover any of the peculiar symptoms.

Result of the repertorization

None of the first ten remedies from the repertorization can be reliably confirmed. We cannot find a combination of the three main (leading) aspects of the case, namely the motor restlessness, problems with coordination and delayed development, in any of them. In order to find the simillimum, we have to work on the presumption that we are looking for a remedy which covers this specific combination. A good strategy to change the order of remedies in the repertorization and to bring forward those, which cover this combination, is to label these rubrics as “elimination”.

Repertorization using elimination method with labeled symptoms # 1, 4 and 6 as elimination

Note: When we label the mentioned rubrics as elimination, only those remedies that are present in all these three rubrics together will appear in the repertorization.

112341 MIND – RESTLESSNESS – children, in (&Elimination)50
212343MIND – RESTLESSNESS – bed – tossing about in172
312343MIND – FEAR – noise, from41
412343GENERALS – DEVELOPMENT – arrested (&Elimination)27
512342GENERALS – FOOD and DRINKS – tomatoes – desire3
612343EXTREMITIES – AWKWARDNESS – Lower limbs (&Elimination)14
712341EXTREMITIES – AWKWARDNESS – Hands – drops things26
812343MIND – CLINGING – children; in – mother; child clings to the6
912342MIND – CONCENTRATION – difficult300
1012342MIND – DULLNESS – children, in30
1112343CHILL – CHILLINESS – night24
1212343MIND – MUSIC – amel.22
1312342MIND – COLORS – red – desire for5

Result of the repertorization:

caust.bufoagar.
20/3617/1715/26
1111
221
32
4112
5
6313
71
8
9311
10112
1111
121
13

Analysis of the elimination repertorization

We excluded both Causticum and Bufo in the differential diagnosis (see above), but Agaricus has come up, which is the only remedy, apart from the two above mentioned ones, that comes through all the three important rubrics.

Although Agaricus is listed in the rubric for restlessness in the first degree only, it is one of its main keynotes as we can confirm in the materia medica. Delayed development, strong clinging to parents and motor restlessness together with the disturbance in motor activity and awkwardness are keynotes of Agaricus.

This situation again demonstrates how important it is to check every symptom carefully in the materia medica. It is important to notice that if we had relied only on the repertory, we could have missed Agaricus very easily.

Agaricus therefore not only covers the characteristic and leading symptoms of the case, but all these symptoms are also its keynotes. It can be found in the rubric “chilliness at night” and this symptom can be confirmed in Hering’s Guiding symptoms of our materia medica[1] where we read in blue letters (so in the second degree) in the chapter “sleep”: Restless night and chilliness.” This not only confirms the chilliness at night, but we can even see it here in connection with restless sleep, which is one of the main complaints of the child.

  1. Vithoulkas writes in his book Materia medica Viva:[2]Agaricus children are slow in walking, talking and learning. Their mind seems to develop slowly, which is why they make mistakes in speaking and writing later. They have a bad memory. They are also slow in comprehending and have difficulty in making decisions. They feel weak and are very attached to and dependent upon their parents. This is the reason why they may develop chorea or convulsions if they have been badly offended or reprimanded by their parents or teachers. Another aspect of Agaricus children is described by J. Metzer in his Materia Medica: “Nervous excessive liveliness of children with mental and motoric restlessness, they laugh, sing, dance and run about in a boisterous manner… With their great restlessness and fidgety nature, these children become a real trial for their parent’s patience. When playing they are wild, boisterous and incredibly agile; in spite of the talent they possess, they are poor achievers at school due to their flightiness. These children have no perseverance due to their mental and physical restlessness, they slip from one thing to the next and show no concentration whatsoever. Because of their fidgeting, they are clumsy with their hands and drop things. When lying in bed they move their bottom rhythmically or roll their head.”

Choice of the remedy, potency, and dosing

We know from the symptomatic picture of Agaricus in the materia medica that the main symptoms of the case (motor restlessness, delayed development, strong dependency on parents, problems with concentration, restless sleep, and motor awkwardness) are keynotes of this remedy. At the same time, the remedy also covers the symptom “chilliness at night”, which can be confirmed in the materia medica. Through a combination of these main and characteristic symptoms, the essence of the remedy Agaricus can be confirmed as G. Vithoulkas describes it in his book Materia Medica Viva. We can therefore confirm the remedy on the basis of the essence and keynotes. Agaricus does not cover the other peculiar symptoms like the amelioration from music and the desire for everything red. However, as it corresponds with the essence, which is unique and original for every remedy, it corresponds with the most important aspects of the case which make it the most individual, and which are the most characteristic of it. At the same time, we can say that no other remedy covers the mentioned combination of characteristic symptoms.

In people who are at the level C7, we should start with a potency up to 200C. Such a recommendation should really be followed in this case because of the serious diagnosis. On the other hand, when comparing the symptoms of the child with the materia medica, the picture of the remedy seems to be expressed very clearly (it contains a lot of keynotes of this remedy), which enables us to give the highest possible potency in his level of health, namely 200C. As the child is not taking any medication yet, it is best to start with a single split dose.

Recommendation: Agaricus 200C single split dose

Follow-up 1: March 10, 2013

The mother gave the remedy to the child on January 26, 2013, and the boy developed a fever on February 14, 2013. During the fever, he woke up frequently for the whole night and it was not possible to calm him down. The mother could not go out even to the next room. He was disinterested in everything, he was sneezing and his nose was obstructed.  On February 15, he developed wandering pains and the fever went up to 39.5°C. On February 16, he was diagnosed with otitis. He got antibiotics and his state got significantly better the next day.

He is much calmer in general and sleeps well. He only wakes once a night and the chilliness at night has improved too. He can play on his own and the aggressiveness is 70% less. His motor awkwardness has not changed. His dependency has improved a lot and he clings to the mother far less.

Analysis of the first follow-up

There has been a general improvement of the boy’s behavior, aggressiveness, dependency on the mother, and the chilliness at night after the remedy. The mother reported spontaneously that the motor restlessness (the strongest symptom of the child) has improved significantly. However, the occurrence of the acute disease with a high fever is the most important piece of information. Every time when the organism regains the ability to produce high fevers after a homeopathic remedy in a person who had not had a fever for a long time, it is a breakthrough moment and we can expect a significant improvement of the chronic complaints, however, provided that such a fever is not suppressed with antipyretics. The boy got antibiotics during the acute disease, which is something that leads to a general relapse in most cases.

A question may arise here how antibiotics can suppress an acute disease when they kill bacteria, which are considered to be the cause of such a disease in conventional medicine. One of the important differences between conventional medicine and homeopathy is that while conventional medicine considers bacteria to be the cause of a particular disease (L. Pasteur‘s theory) and it therefore opts for the therapy of killing the bacteria, homeopathy perceives the presence of the bacteria as a consequence of a disturbance, which allowed development of an environment hospitable to the bacteria and the infection could develop (A. Béchamp’s theory). So if a disturbance of the immune system occurs in an organism and as a consequence, an environment convenient for certain bacteria develops, these bacteria are a mere consequence of this disturbance and their eradication not only does not take away the true cause of the infection, but it also significantly weakens general immunity of the person. Although the infection subsides after antibiotics, these infections have a tendency to recur just because their real cause has not been eliminated with the antibiotics. If the disturbance is really cured, the inner environment inside the organism will change, the fertile ground for the bacteria will disappear and the bacteria will have difficultysurviving easily or to multipling. The person can be considered healthy if he feels well in general and the tendency to recurrent infections decreases. This is very important to realize because after repeated treatment with antibiotics, we often observe that after some time (which is individual for each person and it depends on the general resistance and strength of the immune system), the tendency to recurrent acute diseases like tonsillitis or bronchitis disappears, but chronic complaints develop. In this case, the disappearance of the sensitivity to acute diseases is not a sign of improvement but on the contrary, a sign of a significant decline of the state of the person whose immune system is so weak that it is unable to react through acute inflammatory processes and chronic complaints develop instead. The person then feels generally worse because his general state of health has worsened.

Nevertheless, in this case, there was no relapse after the antibiotics, which means that the child’s organism has a very good level of health, in spite of the seriousness of the diagnosis. The fact that he redeveloped a fever very shortly after the remedy, together with a very strong general improvement, which was not preceded by any perceivable aggravation points to a high level of health too. Although his motor activity is not better yet, his restlessness and psychological level have improved significantly and that (together with the occurrence of the acute disease with a high fever) makes further improvement of his state probable.

Recommendation: wait

Follow-up 2: September 15, 2013

Before they came for the follow-up, the mother had sent me the following e-mail:

“I would say that my son’s IQ has really risen very very much, as far as I can judge it. He concentrates better, and learns and comprehends faster. In comparison to April when I would have given him a mark 0 for the ability to serve himself, now I would rate him with a mark 9. He still sometimes makes troubles with food, but it cannot be compared with the previous state. Drinking from a bottle is the only thing we have not gotten rid of yet. He has learned to ride a bike and he now rides like mad, even without training wheels. On Sunday, he fell over the handlebar but fortunately, he ended up only with a bump on his head. He sleeps alone in his room for the whole night. Only the emotions, they are still as strong as before. Since the last follow-up, he had not been ill until last weekend when he got laryngitis from his brother, which lasted for 3 days. Then it was quite OK, although we had some regression of bedwetting. He should have commenced a school for autistic children, but the headmaster called me on Friday before the beginning of the school year saying that she could not accept him to the school because he was not an appropriate candidate, as he would stand out among other children mentally. She offered me that she could put him into a preparatory class. I was quite terrified, but it turned out to be a good choice. He is like an infant there and reportedly, they had even never had a four-year-old child there, but he likes it there. There are eight children and six of them are autistic. The oldest girl is nine years old. Their usual timetable comprises of daily four-hour teaching so he comes home quite exhausted but psychologically he feels easy. He is the fastest of the whole class to finish his tasks so he is then allowed to play quietly until the others finish their work too, but in spite of that, he never has enough as far as toys are concerned. He comes home and kisses all his tractors. Therefore, in general, he is much better. THANK YOU.”

The boy’s state is even better than at the last follow-up. He has significantly improved in comprehension, he has been removed from the autistic school and goes to a preparatory class at a regular elementary school. He concentrates much better and can stick with one activity longer. He performs tasks and is the quickest from his class. He sleeps through the whole night and the chilliness is still much better. His motor coordination and awkwardness has improved significantly. He can eat on his own, which was not possible before. The fear of noises persists, but he can cope with it better. Fear of the dark is gone and he is still much less restless than before Agaricus. He is also less weepy and cries from more natural reasons, e.g., when he is hungry, and he can be calmed down more easily. His emotional states have been getting gradually better since the beginning of the treatment. He now has bouts of emotions for a few minutes, whereas, in the past, they lasted for hours. Sleep is calmer, he falls asleep more easily, but he started grinding his teeth at night (3) one month ago. Since the last visit, he has had a coryza with thick purulent discharge twice. Both episodes lasted for three days and had a mild course without a fever. His motor coordination has improved a lot and he can eat on his own, ride a bike, and if he is not under strong stress, he sleeps through the whole night.

Analysis of the second follow-up

Since the last follow-up, there has been further improvement, especially of the motor coordination, the ability to serve himself, sleep, and intellect. It is interesting that a new symptom appeared, namely, grinding of teeth at night. If this symptom does not go away, it will probably point to the next remedy the boy may need. However, considering that it is only one symptom, which is not enough to comprise a picture of the next remedy and his state is still getting better, it is necessary to wait in this situation.

Recommendation: wait

Follow-up 3: September 20, 2013 (via e-mail)

“Good evening. I am sending a report since Sunday, September 15, 2013, as agreed during our phone call. On Sunday evening, he woke up with crying 10 minutes after falling asleep. He was saying that he was very sorry and that he had not wanted to do that. Reportedly, a man yelled at him because he had climbed into a tractor and started it up. I calmed him down, he fell asleep again and after another 10 minutes, the situation repeated itself, only with the difference that in this dream, he did not have any friends and his girlfriend who lived very far away and whose name he did not know died. Then, he slept for the rest of the night. Since Monday morning, he has had problems with getting up. He is lazy to get out of the bed and says that he does not want to go to the preparatory class. After breakfast, he calms down, the problem is gone and he leaves excited to see the children and the teacher. He changes his clothes several times in the morning because he is bothered by tight clothes and he makes angry scenes, threatening that he will tear the clothes, kill me, replace me, etc. When he comes home, he has fits of anger from trifles for the whole afternoon, e.g., when his favorite fairy tale is not on TV and he refuses to play it on a DVD, or when he wants to go out and refuses to put on his jacket. He is very quarrelsome and screams all of a sudden, even during common conversation. He then apologizes and says that he feels very sorry about it and that he did not know that. On Tuesday at night, he woke up at around 2 a.m. and came to our bedroom. I took him back to his room and lied to bed with him. After a while, he started demanding nose drops without having any signs of coryza or nose obstruction. I refused and suddenly got punched into my face (he had never done this before and if he was aggressive, he rather gave a kind of a childish smack with his palm and not a direct punch). Then the second and third punch came so I held him and he started kicking me and pulling my hair. Then he started crying and fell asleep. The dream about the death girlfriend repeated itself on Wednesday, this time, it was before afternoon sleep (so it was actually only a vision, not a dream). The girl had an actual appearance and it was his friend from school. She also had a name and the point was that another girl hit her so much that she died and my son missed her a lot. He was restless and I had to stay with him. He woke several times and once he even woke up saying that he wanted his mother but he was looking at me at the same time and although I was talking to him, he was still claiming that he wanted his mother. Then he fell asleep again. The aggression occurs during the day as well. His anxiety has increased. After he comes home, he makes sure that I am still at home maybe 100 times, although he is in the living room and hears me putting dishes to the dishwasher. If I get angry with him, he is very sorrowful, apologizes a lot, makes sure that I stopped being angry and promises not to do it anymore. Every afternoon, he is hell on wheels, capering, climbing the door, jumping off the table, etc. Maybe, he has only not sown his wild oats. He is not used to working and being focused 4 hours in a row, as he has to do in the preparatory class now. At school, he functions like a trouble-free child and his teacher praises him a lot. She says that he works very nicely and behaves well to the other children. I am getting the impression that she must think that I make all this up. He started reading this week, he already knows four words, and he started counting to two. At home, he recognizes only when something is one, and what is more than one, he one time describes as five, the other time sixteen or three. In short, he says the first number that comes to his mind at that moment. This afternoon, he wanted to go out in spite of rain, but then he cried and got angry because he did not want to take a hood. In the end, he said that he did not want it because he would look like a bogeyman and other children would be afraid of him although there was nobody outside and he normally wears the hood without problems. The opinion of his psychologist is that it is a typical sign of autistic behavior because he subconsciously reacts to a change, and although he likes the change, he tries to alter it subconsciously and that is why he is aggressive at home.    

Analysis of the third follow-up

At this moment, it is evident that some symptoms are starting to worsen. According to what his mother and his teachers say, the boy is still generally better than before the remedy. The aggressiveness, which improved first, has started getting worse again. The other symptoms (motor restlessness, bad coordination, delayed mental development and chilliness at night) remain better and they are not coming back. On the other hand, some new symptoms have appeared, namely night terrors with aggressiveness and fear with a need to stay close to the mother, which can be interpreted as an increase of his dependency. However, the difference is that whereas the dependency was constant before, now it only occurs when he has nightmares. The fact that the aggression is followed by subsequent sorrow could also mean that the boy does not fully control these states. The new symptom from the last follow-up, the grinding of teeth is still present and it occurs every night.

In situations in which the first remedy has acted well and there is a partial relapse after a certain period of time, we always have three basic questions to answer:

  1. Is there anything that could have provoked the decline (relapse) or is the relapse spontaneous?
  1. Are the original symptoms coming back (complete relapse) or are only some of them present together with some new symptoms (partial relapse)?
  1. And finally, the most important question: Shall we wait, or is it necessary to give a remedy at this moment?

Before we make any further recommendations, it is necessary to understand what is going on with the person first, otherwise the next course of action (including a choice of the next remedy) could be counter-productive.

I have not been able to find the answer to the first question, so we can say that the decline in the boy’s state is spontaneous. If we had found the triggering cause, it would have been better to wait a few days and see whether the organism deals with the imbalance on its own and whether a spontaneous improvement starts, which is often the case. However, if the relapse is spontaneous, the situation is more serious and the probability that the organism has enough power to regain balance and improve on its own is very low and it is rather an exception.

The answer to the second question was actually discussed during the analysis of the follow-up where we found out that the original keynotes of Agaricus had not come back, but some new symptoms had appeared. Why is it important to know this? If the decline is accompanied by a return of the original keynotes of the remedy which acted as a simillimum, we speak about the so-called complete or full relapse and it is necessary to repeat the original remedy. In a case of a spontaneous relapse, we use a higher potency and in an induced relapse (if the organism is not able to regain the balance on its own), the same potency. If we observe a return of only a few original symptoms and some new appear (provided that the previous remedy acted well), we speak about the so-called partial relapse, which is exactly what is going on in this case.

The last and the most important question that remains to be answered is whether we shall recommend another remedy or wait further. The answer is never easy, especially when we know that the previous remedy acted well and caused long and complex amelioration. There is quite a high risk of disturbing the action of the previous remedy if the new remedy is not accurate and given at an inappropriate moment. There are two important guidelines here which should help us decide:

  1. How intense the symptoms are and whether the situation allows us to wait (of course, including the medical point of view because the health of the person is a priority).
  1. Whether the new symptoms comprise a clear picture of a remedy. In other words, whether the combination of the new symptoms together with those that returned puts together a key combination of some homeopathic remedy.

In this case, the main and most intense symptoms are the aggressiveness, night waking with fear, anxiety and need for contact, and the grinding of teeth at night. These symptoms correspond with the remedy Stramonium. The fact that although the aggression is impulsive and very strong, at the moments where the boy is not aggressive, he looks rather shy and nobody would expect him to behave in such a manner, is also in favor of Stramonium and it is frequently observed in children who need this remedy. Considering that the symptoms clearly point to this remedy and they are very intense, and at the same time, the decline has been spontaneous, I decided to recommend this remedy in a 200C potency.

Recommendation: Stramonium 200C

Follow-up 4: September 27, 2013 (on the phone)

The mother is called one week after our last follow up and said that it took her longer to get the remedy and that her son’s aggressiveness and sleep has improved. She is asking whether she shall give him Stramonium anyway.

Analysis of the fourth follow-up

As the boy started getting better spontaneously and the improvement is accompanied by disappearance or significant amelioration of Stramonium keynotes, it is not possible to give the remedy. What would happen if the boy got Stramonium?  It is possible that the remedy would not influence the case at all, but it could also disturb the previous positive effect of Agaricus. So I recommend waiting.

Recommendation: wait

Follow-up 5: October 2, 2013 (via e-mail)

“I am writing because my son’s neurologist provided us with the results of the EEG test and I want to share them with you. The EEG is normal and both cerebral hemispheres are working properly. Although this does not exclude Asperger’s syndrome because there do not tend to be EEG findings in this syndrome (unlike other autistic disorders), there has been a tremendous progress of my son’s state since February.”

Analysis of the fifth follow-up

This is a breakthrough piece of information for me because it proves that the improvement the mother is describing is not only subjective but also objective. The fact that the EEG went back to normal means that the remedy has really affected the disturbance in depth. Regardless of the physician saying that a normal EEG does not exclude Asperger’s syndrome, the boy had abnormal EEG findings that confirmed a non-functional left cerebral hemisphere before the homeopathic therapy. As his intelligence and mental capabilities including concentration have improved significantly, it is probable that the improvement in the functioning of his brain, now also confirmed by the EEG, is partially responsible for it.

Recommendation: wait

A word in conclusion:

I keep following this case because, in spite of this improvement, the boy is still not free of complaints (the increased emotional sensitivity, weeping and management of occasional acute diseases, which is a very favorable development in such cases). It is very probable that the boy will need several other homeopathic remedies before the maximum effect which homeopathy is capable of is reached.

[1] THE GUIDING SYMPTOMS OF OUR MATERIA MEDICA BY CONSTANTINE HERING. Agaricus muscarius [online], [ cit. 8.1.2015 ]. http://www.homeoint.org/hering/a/agar-8.htm#37

[2] VITHOULKAS, G. Materia medica Viva. Volume 1. London: Homeopathic Book Publishers, 1995. ISBN 0-9522744-69, p. 129-130

About the author

Petr Zacharias

Petr Zacharias

Petr Zacharias is the founder and main teacher at the Prague College of Classical Homeopathy. He studied with George Vithoulkas at the IACH and has conducted seminars with Dr. A. U. Ramakrishnan, Dr. S. K. Banerjea, Dr. Jorgos Kavouras and Erik van Woensel.

10 Comments

  • really an excellent case!!
    Thank you so much for it and if possible keep providing us with this kind of analysis!!!
    As an IACH student my self i am really glad to see the amazing result of the correct way of practicing classical homeopathy, and being able to study from somebody who’s being tough by the same teacher is truly a delight!
    Through this you provided us with a complete way of approaching a case- and with the meaning of every step, according to prof. Vithoulkas teaching. I especially enjoyed the part of the three questions after the relapse, that is an issue that we definitely have to deal with!!
    So eventually, since 2013 did the chikd needed anything else? How is his current situation?
    best regards!!

    • Dear Angeliki, I lost the contact with the mother so unfortunatelly I dont know what is the current situation but as far as I know the amelioration which was reached is still there.

  • Dear Petr,
    it was really pleasure to reed this article, it is very informative, thank you. I don’t understand only how it is possible that half of the hemisphere don,t work ? What it means exactly?

  • thanks a lot sir for this detailed case. learned a lot.
    one query is that “how its possible that a symptom can not be in materia even though its present in repertory?”

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