Clinical Cases

Epilepsy in a Man of 35

epilepsy

Dr. Chandrabhan Mahesh Sharma presents a case of epilepsy in a Man of 35. The simillium required the antimiasmatic remedy Tuberculinum to facilitate its action.

AIMS/OBJECTIVES OF CASE

  1. To understand the clinical picture of a case of seizure disorder
  2. Evaluation of the ‘mental state’ of a patient with the help of ‘life space table’ (An ICR tool).
  3. Understanding the importance of studying ‘mental state’ in formulation of totality and selection of simillimum.

INTRODUCTION OF SUPERVISORS

This case was done as per ICR methodology under consultation of Dr Kumar Dhawale (MD Psychiatry) and supervision of Dr Manoj Patel MD (HOM), HOD of department of Psychiatry and Dr Sunita Nikumbh MD (HOM), Reader of department of Psychiatry at Department of Neuropsychiatry, Dr ML Dhawale Memorial Homoeopathic Institute, Palghar, India.

PRELIMINARIES                                                   

Name: N.S.                    Age: 35yrs                             Sex: Male                                                 Education: 8th std             Occupation: Unemployed      Marital Status: Single                                                                Religion/Caste: Muslim/Shiya         Diet: Mixed                           Father Age: 72 years                            Mother Age: 57 years                         Siblings Age: Brothers 36 years, 30 years, Sisters- 27years

CHIEF COMPLAINTS

No.LocationSensation and PathologyModalities A.F.,<,>Accompaniments
1CNS- Brain

Since 10-15years

O-Sudden

D-15-20 minutes

P- Progressive

F- Initiallly-2-3 times/day

Since 2014- Once/month

 

 

Convulsions:-

Pre ictal phase-

-Movement of  B/L hands2

Ictal phase (4-5 minutes )-

-Unconsciousness

-Up rolling and redness of eyes2

-Frothing from mouth2

-Deviation of mouth2

-Tongue bite2

-Vomiting of indigestible things2

-Involuntary passage of stool/urine2

-Stiffness2 of whole body

-Twitching/Jerking2 of whole body

-Profuse Perspiration2

Post ictal phase (10-15 minutes )-

-Sleepiness2

-Weakness2

H/o head injury

<Anger when2

<Sleep after2

<Full moon2

>Tab Levera 750mg BD

>Tab Cloba 10

 

 

PHYSICAL CHARACTERISTICS

Appearance- Fair complexion, well groomed, maintaining eye contact, obese, nose-broad, straight, right eye squintPerspiration- Moderate2 specially on face2
Appetite- Hunger- causes irritabilityAversion: sweets2

Craving: Pungent3, Chicken2, Salt2, Tea2, Warm food2

Reactions-physical factors: Sun aggravationThermal: Hot

 PATIENT’S/MOTHER’S OBSTETRIC HISTORY: FTND, LBW, H/O delayed cry for 5-10 minutes, Neonatal Asphyxia

DEVELOPMENTAL LANDMARKS/PROBLEM: N

PAST HISTORY: Family history- Mother HTN/OA, Brother- DM

LIFE SPACE:

Patient was born and brought up at M. His father is a businessman and his mother is a housewife. Patient is 2nd child of his parents. Patient has 3 siblings, 1 elder brother, 1 younger sister and 1 younger brother.

is fHis father is very domineering by nature. Patient had fear of his father in childhood. Mother is calm and quiet by nature. Mother does not reply to anyone and she remains quiet if her husband scolds her.

Most of the time the mother suppressed her anger when anyone scolded her. Patient easily gets angry at trifles. Even during case taking patient scolded his mother 2 -3 times because when she was narrating the complaint of the patient, he thought that she was criticizing him. Patient went to school up to 8th standard and left school after that because he was not interested in study.

He was not able to read and write until 8th standard. Still patient’s recalling capacity is poor. Patient took education in Urdu medium. As patient was very weak in study, his parents paid more attention to him, and tried to fulfill all his demands.

Since childhood patient is very obstinate and demanding. Now patient demands money from his mother and brother. If they do not give it to him, he becomes irritable, abusive and throws things.  Many times, he stole money from the pocket of his brother and the cash counter of the shop.

He wants money to eat outside food and to drink tea. Patient has addiction of tea. He takes tea 5-6 times per day. Patient cannot tolerate contradiction. One year ago patient’s sister asked him to do some work, but he refused and broke a mobile phone in anger. He said,”I am older than you, you don’t have any right to ask  me to do any work”.

Patient is very egoistic. Three years ago the patient’s father asked him to bring milk. Patient refused to obey his command and replied back to his father. So, his father got angry and scolded him. Patient also became angry but did not express anger towards his father. He expressed his anger towards his mother and siblings.

Patient is indecisive by nature. Patient is very unskilled in purchasing, selling and marketing because of poor mathematics. Fifteen to twenty days ago patient’s mother asked him to bring fish from market but he paid extra money to the shopkeeper because of poor math skill.  Patient is fastidious by nature and does not allow anyone to wash his clothes. He is never satisfied with the clothes washed by family members.

PHYSICAL EXAMINATION:

General examination-P0/I0 /O0/CY0/ C0, T-Afeb/ P 80/m/R16/m/BP-120/80 mmhg
Systemic examination-CNS- conscious oriented, sensation and motor function normal, reflexes normal, muscle strength normal

 INVESTIGATIONS DONE: MRI 23/12/14 Gliotic changes noted in the b/l parietal region predominantly on right side with paucity of white matter is likely the sequel of ischemic insult in perinatal period.

DIAGNOSIS: Remote symptomatic generalized epilepsy with tonic clonic seizures

LIFE SPACE TABLE:

 NoEvent / Key wordOnsetDurationLife-SpaceCharacteristics ExpressionPPT FactorsAttributesInterpretation
1.IPR with fatherSince childhoodDominating father-Fear of father-Sensitive to reprimand+
2.IPR with motherSince childhood-Mother calm and quiet

-When mo speaks about his complaint to anyone

-Anger2

-Scolding to mother

-Feeling as if back bitching for him

<Trifles2-Irritable2

-?Image conscious

3.Obstinate and demanding childSince childhood-He likes outside food and drinking tea.-Demanding for money2

-If not given- than gets angry2, abusive2, throwing things2, stealing money2

 

 

<Contradiction2

-Irritable2

-Demanding2

-Obstinate2

4.Egoistic person-Relatives ask to do house hold work-Refuses for work2

-Anger2

-Breaks mobile2

-Saying he is elder so he will not do any work (to younger person)2

-Anger suppressed+ (Towards father)

<Contradiction

 

 

 

 

 

<Fear2

-Egoistic2

-Irritable2

5.Fastidious person-He does not allow anyone to wash his clothes, because he is never satisfied with the clothes washed by family members.

– If anyone spoils things in front of him

-Angry2, shouts2 and cleans that thing.-Fastidious2

-Irritable2

 

MENTAL STATE

Emotional state

Anger-Irritable, <Contradiction2, <Trifles on2, Abusive2, Violent2, Shouting2, Anger suppressed+

-Love-Attachment, Self2, Money2, Egoistic

-Fear- Sensitive to reprimand2

Intellectual state: Memory weak2, Thinking sluggish2 and Indecisisve2, Orientation poor, Confidence poor, Judgement poor, MWD weak

Reaction: A.F., <,>: state effects:- <Contradiction (Anger, Obstinacy), <Trifles2 (Anger), <Fear+ (Sensitive to reprimand2)

Action/ Behavior:- Aggressive2, Fastidious2, Demanding2, Obstinate2

 TOTALITY:

Mental characteristicsClassification of symptomsPhysical characteristicsClassification of symptoms
Anger <contradiction2Emotional aggravating modalityPerspiration on face2Physical general
Anger <trifles on2Emotional aggravating modalityIntolerance of hunger2Physical general
Anger-violent2EmotionalSun <Physical general
Anger-abusive2EmotionalAversion sweets2Physical general
Anger-shouting2EmotionalCraving pungent3Physical general
Sensitive to reprimand2EmotionalCraving chicken2Physical general
Weak memoryIntellectualCraving salt2Physical general
Sluggish thinking2IntellectualCraving tea2Physical general
Indecisive2IntellectualCraving warm food2Physical general
Fastidious2BehavioralThermal hotPhysical general
Obstinate2BehavioralConvulsion anger after2Physical general
Demanding2BehavioralConvulsion full moon2Physical general
Convulsion sleep after2Physical general

CONTRIBUTION TO THE TOTALITY:

In this case, anger from contradiction and from trifles is the emotional aggravating modality. Violent, abusive, shouting in anger, sensitive to reprimands are emotional expressions of the mental state. Weak memory, sluggish thinking and indecisiveness are intellectual expressions of his mental state. Fastidious, obstinacy and demanding are behavioral expressions of his mental state.

MATERIA MEDICA DIFFERENTIATION: Natrum Muriaticum vs Staphisagria

The patient is irritable, egoistic, unintelligent, has weak memory, is indecisive, obstinate, demanding and fastidious. Natrum Mur and Staphisagria are the remedies that come closest. Along with this, considering physical characteristics and convulsion from anger and full moon, Natrum Mur as the closest remedy.

FINAL REMEDY CHOICE: Natrum Mur 200 1PHS weekly.

IMPORTANCE OF MENTAL STATE IN SELECTION OF CORRESPONDING REMEDY:

Here mental states of the patient helped us to formulate the totality and finer differentiation of the closest remedies. Similar expressions were observed in both remedies but the characteristic expressions at the emotional level like violent anger from contradiction and trifles, mentally weak, fastidiousness, obstinacy helped to differentiate them.

FOLLOW UP CRITERIAS

SR NOCRITERIASSR NOCRITERIAS
1Irritability5Convulsion intensity
2Anger-violent6Convulsion duration/frequency
3Appetite7Any new co
4Thirst8Use of anti epileptic medicines

 

DATE 12345678RX
JAN 2016SQSQNN000SQRII
FEB

2016

SQSQNN000SQRII

NATRUM MUR 200 1PHS/WEEK

CUPRUM MET 200 STOCK

(SOS)

MARCH 2016SQSQNN>++3 epi

(2 in 1st fortnight on alternate day

1 in last week after 15 days of last episodes)

0SQNATRUM MUR 2OO 1PHS/WEEK

RII

 

APRIL 2016>20%>20%NN000SQCT ALL
MAY 2016>20%>20%NN>++Once/2 week0SQCT ALL
JUNE /16GAP
JULY/16>25%>25%NN000SQCT ALL
AUG/16>25%>25%NN000SQCT ALL
SEPT/16>30%>30%NN000SQCT ALL
OCT/16>30%>30%NN000SQCT ALL
NOV/16<+<+NN<++In first week-2-3 episodes for one day

In 3rd week 1 episode appeared

0SQ1ST week- Cuprum met 200/1 dose

RII

In 3nd week/

4th week Tub. 1m

Natrum mur 200 3phs

RII

DEC/16>++>++NN000SQNATMUR 200 3PHS

RII

JAN/17>++>++NN>+1 epi0SqTUB 1M PHS

NAT MUR 200 3PHS

RII

FEB/17>50%>50%NN>+1epiCold/

coryza

SQGELSE200/QDS/4

DAYS/ACUTE

NAT MUR 200 3PHS

RII

MAR/17>50%>50%NN00Skin eruption/coldSQPULS 200 QDS/4DAYS/ACUTE

NAT MUR 200 3PHS

RII

APR/17>50%>50%NN000SQCT ALL
MAY/17SQSQNN000SQCT ALL
JUN/17SQSQNN000SQCT ALL
JULY/17>50%>50%NN00Injury on legSQARNICA 200/QDS

NAT MUR 200 4PHS?

RII

AUG/17NN>++1 EPI0SQCTALL
SEPT/17SQSQNN000SQCT ALL
OCT/17SQSQNN000SQCT ALL
NOV/17GAP
DEC/17SQSQNN0O0SQCT ALL
JAN/18SQSQNN>1 EPI0SQCT ALL
FEB/18NO ANY COCT ALL
MAR/18NO ANY COCT ALL
APR/18NO ANY COCT ALL
MAY/18NO ANY COCT ALL
JUNE/18>+60%>60%NN>1EPI0SQTUB 1M 1PHS

CT ALL

JULY/18NO ANY CO
AUG/18>60%>60%NN>++1 EPI0SQTUB 1M 1PHS

CT ALL

Tuberculinum was used as an intercurrent based on over-all features of the tubercular miasm: disease activity, mental state, generals and birth history.

Natrum Mur was the most similar remedy yet it did not evoke the desired result. This led to the introduction of an antimiasmatic remedy.

Cuprum Met was used as a phasic when needed based on the symptoms of convulsion.

Gelsemium & Pulsatilla were prescribed for acute conditions of cold and skin eruptions.

FOLLOW UP SUMMARY: After prescribing, Natrum Mur 200 1phs the intensity, frequency and duration of convulsions reduced up to 70-80%. One AED i.e. Tab Cloba stopped. Irritability reduced up to 60-70%. Initially patient was at home and now he has started to go shopping with his brother. No any new complaint appeared since last 3 years showing improvement in susceptibility.

CONCLUSION: Natrum Mur is the indicated remedy that was prescribed upon different expressions of his mental state along with physical generals and it showed effective results on every aspect from mentals, physicals and particulars.

 

About the author

Chandrabhan Mahesh Sharma

Chandrabhan Mahesh Sharma

Dr. Chandrabhan Mahesh Sharma MD (HOM) Psychiatry from MLDMHI, Palghar (India). Junior Research Fellow Alumini at MLDMHI, Palghar. Dr. Sharma completed his dissertation on epilepsy for MUHS, Nashik (India). He has given presentations on national and international platforms on the topic of epilepsy and homoeopathy.

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