Epilepsy in a Man of 17

Introduction:

P.C.  came with his father to our hospital OPD.  He was suffering from nocturnal epilepsy only (no daytime convulsions) This is a case of the consequences of long term undiagnosed and untreated nocturnal epilepsy on the development of a child.

Case Record

D.O.C: 23/1/18

Name P.C.

Age: 17 years (D.O.B.: 16/01/2001)

Sex: Male

Education: 10^th fail

Religion: Hindu

Vegetarian

Father: 46 yrs

studied up to 12^th std.

Working in dairy as a boiler attendant

Mother: 35 yrs

studied up to 4^th std.

Housewife

Br: 1 Younger  15 yrs.  (Normal )

study …9^th std

PG Mother: 70 yrs

Chief complaint :

PHYSICAL GENERAL

Appearance: Thin ++

Wt:  50 kg

Ht: 5’ 5”

Frequently protruding tip of tongue ++ while he is in deep thought

Skin:  Dark brown , ++ dry +

Eyes :  Vision poor ++ (Glasses) àNumber – 1 ½  in both eyes but not wearing spectacles.

Perspiration : +++ Whole body,  Offensive odor++ , white stain +

Digestion  :  Eating large quantities ++  Whatever being served ..

Craving :  Sweets ++, Chocolate ++, Ice cream++.Pulses ++, Salt +

Elimination: Stool: once/ Daily regular

Urine: Regularly

Birth History: Mo’s Obs. H/O:  Mother had one induced abortion in 2^nd month of pregnancy. Doctor’s advice not to conceive before 6 months. But mother conceived in 3^rd month. ( i.e pt)

Delivery:  Normal. Nausea and vomiting throughout 9 months.

Birth weight: 3 kg,  Poor cry after birth.  Twice made effort to make a loud cry.  Hypoxic brain damage…No immediate problem to pt. after birth.

Milestone: Time of dentition, walking and speech not remembered by parents. But dentition was early and he had diarrhea at that time.

Vaccination : Given at appropriate time, no known adverse effects

Thermal state : C2 H2    Doesn’t  prefer sweater in cold .. Taking water whatever being served. Not Respiratory problems in any season.

Sensory input: As mentioned in C/C.

Sleep: Deep ++ not awakened by loud noise … but startled ++ during sleep with very loud  noise ++ &  touched from being++      Sleep Position :  Not sp.

P/H/O: Not significant

F/H/O : PGfa : IHD, D.M, Gangrene died in 1996      PG.Mo : Br.Asthma

Psychiatric Opinion    Date : 18/9/2018

Provisional diagnosis: with seizures

MRI Brain (7/8/2018) :  Normal study, no definite focal lesion

MRI brain epilepsy protocol (20/8/18): normal study.

EEG impression (14/8/18) : abnormal EEG

IQ Test at Civil Hospital Mehsana (8/18):  Borderline IQ

Lab Investigation:    ( 8/18 )  Haemogram Report: NAD

Life Space: Information supplied by father and cross checked with his mother and pt. They did not remember exact age of onset of c/c.  Didn’t know about milestones and had not gone for any treatment till date. The father expected patient to pass 10^th by any means. After that he wants to put him in the army. Apparently academic performance was the reason he came for treatment.

Master P is the first male child in his family. He belongs to Chaudhary middle class family. Father is working in a dairy as a boiler assistant at Mehsana. Father studied up to 12 th (fail). Mother is a house wife, studied up to 4^th std. There is 11 years gap between parents’ age.

P.G. father expired before the birth of pt. P.Gmo is 70 years old and living with pt.  They haven’t consulted any doctors till date., i.e in 13 years of convulsions. They did dora-dhaga religious rituals. Father consulted after poor academic performance of pt in 10^th.( failed in all subjects)

Initially up to 4-5 years of age, patient had cordial relations with all family members and friends. Never had any problem in any relations. Father is more attached to pt and understands his each and every activity. Mother is more duty bound so pt has had quarrels with her in recent years.  P.G. Mother having similar relations like mother. Initially nobody recognizes any problems up to 4-5 yrs of age.

Gradually his academic performance deteriorated. He became easily fooled by others. Eg. if somebody gives him work to do, he immediately does that work irrespective of his work or time. Same if somebody ask him for things. He doesn’t understand anything about motives of others gives immediately.

Father called him “Foolish (Latth) “in front of PP. And pt has this image among his friends and in school. Sometimes children used to mock him as a “foolish mad boy”. Pt had no effect from this and next day he is same as usual.

Pt. doesn’t understand any advice or punishments from any family members. He will behave the same on the next day. Although he plays with friends, he does not understand proper rules of the games.

He doesn’t take care of himself while playing. Once he was hit by a big nail on the back of his head while swinging. That time there was much bleeding from the wound. But he didn’t cry.

There was a fight among school friends regarding a pencil. They were trying to claim pt’s pencil. Pt got angry and wanted hide his pencil in his mouth….which he accidentally swallowed later. In all these incidences, he never cried and also didn’t understands the social effect of them.

When his demands aren’t met he becomes excited and starts shouting.  Pt is quiet and shy outside home, but obstinate, demanding and aggressive at home.

Totality: Reportorial totality.

Boger approach:

1. Convulsion During Sleep
2. Convulsion in night 4-6 am
3. Starting sleep during
4. Starting touch from waking him)
5. Startling very loud noise from
6. Perspiration excessive
7. Perspiration offensive
8. Appetite voracious
9. Cr: Sweets
10. Vision weak
11. Careless
12. Foolish
13. Quarrelsome

PDF

1. Thermal state: Ambithermalà Hot
2. Tubercular Miasm
3. Brain
4. Violent
5. Abusive

  FINAL SELECTION  à Stramonium  Dose : 1M   Repetition : 1d/wk

 

Follow up criteria :

1. Sleep /convulsion /Startled
2. Behaviour -Abusive /Shouting/carless
3. Cognitive functions – Memory and Understanding
4. Any new syms. O/ E

Treatment started on 23/1/18

First Rx : Stramonium 1m 1p HS /Wk , S.L 200TDS

Date	Sleep Convulsion Starting	Behaviour Abusive / Shouting/ carelessness	Cognitive functions Memory and  Understanding	New symptoms	Action
3/2/18	G/ > 2 50 % Better In Convulsion	? >	–	–	Stramonium 1M 1d /wk S.L 200 TDS
23/2/18	G/ >2 OCC. + Jerking	++ Too much foul language to parents	–	–	Hyoscyamus 1M /1p wk SL TDS FOR 2 Wk
26/3/18	G/ ++	S	–	–	Stramonium 1p HS/Wk SL TDS
11/4/18 Report to other physician					Ct all
1/5/18 Report to other physician	G/>   Better with Medicine	+ Shouting	–	–	Ct all
26 /5/18	G/ >	>+ Abusive Language			Ct all
19/6/18	G/ > 2 Occ +	>	Forgetful +++ Fail in exam		Stramonium 3p /HS S.L  TDS
13/7/18	G/>2 Occ+	>		Over all >2 More than 50 %	Ct all
7/8/18	G/>2 Occ+ Startled < Loud voice	Abusive >3 Very calm down Give answer after asking twice		Advice Investigation IQ test, MRI, CT scan Opinion of Neuro physician	Ct all
28/8/18	G/ Same as last time	Abusive +	O/E: Mental status: Mild Cognitive problem Physical exam: Tandeem gait : Fail Reflexes: NAD Babinski R: + Extension Hypertonia, Spsticity++, Power : N 5/5 All other Neuro : NAD	CBC , CT brain, MRI epilepsy protocol: NAD EEG : Abnormal IQ : Borderline	Tub 1M 1p Stram 1M 3p HS SL TDS For 1wk

 

LOCATION	SENSATION AND PATHOLOGY	A/F. & MODALITIES <, >	ASSOCIATED SYMPS
BRAIN		? A/f  Hypoxic brain injury poor cry after birth)
O: 2004-05 (3-4 yrs of Age)	Repeated  Convulsion In Night time during sleep only+++	< Between 4-6 am in sleep ++ <Early morning+
Fr: Almost daily	Before convulsion :   No any symptoms
D: For 1-2 month	During :
Duration tonic : 10-15 seconds Clonic :  few seconds  to minutes ( ?1)	Tonic: Violent stiffening of muscles of whole body++ (  lakkdi je vu ) Breathing stopped ++ Cyanosed ++ Teeth clenching +++ salivation++ Clonic: Shaking / jerking of whole body.	Didn’t go to any doctors. Doing religious rituals for relief (Dora- Dhaga)
	After convulsion: Not waking from sleep Sleep continuously and deep Not unconscious
	No effect on Bladder , Bowel
	No Headache or any effect on mood/ mind next day.  Doing  Routine activities  as usual
Now
O: After 1- 2 month (2008)	Change in the pattern of convulsion
Frq: Almost daily Multiple times in night Duration : For few seconds (5-10)	Clonic: Only Jerking  & Shaking of whole body+++ during night sleep onlyà Not waking from sleep. Change different places in bed in sleep without any consciousness. Deep sleep.	< Night time Sleep during +++ Not any particular time
	No  tonic  phase
	Not any before and after symptoms.   Starting ++ without  awake from sleep	< Touch ++ ( to wake him up ) < Very loud noise ++
Mind	Cognition:   Deteriorate in School performance ++
Gradually	Passing marks up to 9 th std. Fail in all subjects in 10th std.++
	Can do his daily activities on his own. Foolishà Taking advantage by others . Carless attitude , multiple injuries ++ Memory poor +++ for study No effect of any punishment on next day.
Behaviour	Violent ++  beating to friends un controlled , breaking things++.	< Contradiction++
Since last few yrs	Quarrelsome & Abusive at home  +++ If demands not fulfilled

Summary: This case demonstrates the consequences of long lasting undiagnosed and untreated nocturnal epilepsy. Illiterate parents and poor socioeconomic status added fuel in the sufferings. The correct homeopathic medicine, Stramonium, gave long lasting relief.  He got almost 90 % relief in his chief complaint. He took the remedy for almost one year.  Now he has not taken medicine since last year. He is stable and has a job in a private company. Overall, his parents are very satisfied with the outcome.