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.
Age: 17 years (D.O.B.: 16/01/2001)
Education: 10th fail
Father: 46 yrs
studied up to 12th std.
Working in dairy as a boiler attendant
Mother: 35 yrs
studied up to 4th std.
Br: 1 Younger 15 yrs. (Normal )
study …9th std
PG Mother: 70 yrs
Chief complaint :
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
Birth History: Mo’s Obs. H/O: Mother had one induced abortion in 2nd month of pregnancy. Doctor’s advice not to conceive before 6 months. But mother conceived in 3rd 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 10th 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 4th 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 10th.( 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.
- Convulsion During Sleep
- Convulsion in night 4-6 am
- Starting sleep during
- Starting touch from waking him)
- Startling very loud noise from
- Perspiration excessive
- Perspiration offensive
- Appetite voracious
- Cr: Sweets
- Vision weak
- Thermal state: Ambithermalà Hot
- Tubercular Miasm
FINAL SELECTION à Stramonium Dose : 1M Repetition : 1d/wk
Follow up criteria :
- Sleep /convulsion /Startled
- Behaviour -Abusive /Shouting/carless
- Cognitive functions – Memory and Understanding
- Any new syms. O/ E
Treatment started on 23/1/18
First Rx : Stramonium 1m 1p HS /Wk , S.L 200TDS
Abusive / Shouting/
Memory and Understanding
|3/2/18||G/ > 2
50 % Better In Convulsion
|? >||–||–||Stramonium 1M 1d /wk
S.L 200 TDS
OCC. + Jerking
Too much foul language to parents
|–||–|| Hyoscyamus 1M /1p wk
FOR 2 Wk
|26/3/18||G/ ++||S||–||–||Stramonium 1p HS/Wk
Report to other physician
Report to other physician
Better with Medicine
|26 /5/18||G/ >||>+ Abusive Language||Ct all|
|19/6/18||G/ > 2
Fail in exam
|Stramonium 3p /HS
|>||Over all >2
More than 50 %
Startled < Loud voice
| Abusive >3
Very calm down
Give answer after asking twice
MRI, CT scan
Opinion of Neuro physician
|28/8/18||G/ Same as last time||Abusive +||O/E: Mental status: Mild Cognitive problem
Tandeem gait : Fail
Babinski R: + Extension
Power : N 5/5
All other Neuro : NAD
|CBC , CT brain, MRI epilepsy protocol:
EEG : Abnormal
IQ : Borderline
|Tub 1M 1p
Stram 1M 3p HS
|LOCATION||SENSATION AND PATHOLOGY||A/F. & MODALITIES
|BRAIN||? A/f Hypoxic brain injury
poor cry after birth)
(3-4 yrs of Age)
In Night time during sleep only+++
|< Between 4-6 am in sleep ++
|Fr: Almost daily||Before convulsion : No any symptoms|
|D: For 1-2 month||During :|
: 10-15 seconds
Clonic : few seconds to minutes
|Tonic: Violent stiffening of muscles of whole body++
( lakkdi je vu )
Breathing stopped ++
Teeth clenching +++
Clonic: Shaking / jerking of whole body.
|Didn’t go to any doctors.
Doing religious rituals for relief
Not waking from sleep
Sleep continuously and deep
|No effect on Bladder , Bowel|
|No Headache or any effect on mood/ mind next day. Doing Routine activities as usual|
|O: After 1- 2 month
|Change in the pattern of convulsion|
Frq: Almost daily
Multiple times in night
Duration : For few seconds
|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.
|< 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.