EPILEPSY

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EPILEPSY

EPILEPSY

Ques. 1     What is Epilepsy?

Ans.          It is a condition on sudden paroxysmal disorder of cerebral function (dysrhythmia of the brain) marked by inhibition of functions of the higher centers of the cerebrum involving either a small area of a large part of it resulting in uncontrolled activity of this and other parts of nervous system.

Types :

  • Symptomatic (or secondary) – where a definite cause is present.
  • Idiopathic (or primary) – without an obvious cause.

Ques. 2     What are the causes of epilepsy?

Ans.          Causes of Symptomatic Epilepsy ; I. General- Poisons- alcohol, lead, insecticides. Matabolic disorders, uraemia, hypoglycaemia etc. Cerebral anoxiants-asphyxia, heart block etc.

  1. Local : Vascular lesions – cerebral embolism. Trauma-birth injury, head injury. Inflammatory-encephalitis, meningitis, Congenital-tuberose sclerosis etc, Degenerative - presenile dementias.

Classification of Idiopathic Epilepsy:

  • Local – Temporal lobe Epilepsy, Jacksoniam Epilepsy, Grand mal Epilepsy with focal (partial) onset.
  • Generalised- Grand mal Epilepsy, Petit mal Epilepsy, Myoclonic seizure, Tonic seizure, Akinetic seizure.

Ques. 3     What is the Minor Epilepsy (or petit mal)?

Ans.          This is an idiopathic type of epilepsy, occurring commonly in young age. The attacks are frequent, even several hundreds per day. (Without any of the discoverable organic disease of the brain or other known cause of fits.)

Clinical Features are :

  1. Amnesia, which may be short.
  2. Jerky movements of short duration, eyelids, face, arms.
  3. Consciousness is restored rapidly and fully.
  4. The frequency of attacks usually diminished with age.
  5. Sudden loss of consciousness without aura and with little or no clonic or tonic movement.
  6. Staring expression with eyes set straight ahead.

Ques. 4     Describe Grand Mal (or Major) Epilepsy?

Ans.          The description of Epilepsy is :-

  • Onset : Any time but usually when the patient just falls asleep or gets up from bed.
  • Other possible factor : Due to some drugs, Alcohol; due to metabolic changes (viz. hepatic failure, uraemia hypoglycaemia etc.) Degenerative brain diseases; cerebral infarction; cerebral neoplasm etc.
  • Clinical Feature : Premonitary symptoms- Prior to the attack there may be a change of mood or behaviour for few days.
  • Exciting cause : Overwork, fatigue, hunger, excitement, alcoholic debauch, pyrexia etc. Age- Usually after 2 years to 20 years.

Attack- consists of six stages:

  • Clonic Phase- Lasts for about a minute. Short jerky movement of different muscles, asphyxia relieved, saliva mixed with air bubbles come out of the mouth. Breathing starts and cyanosis disappear.
  • Flaccid coma & sleep- Starts of relaxation of muscles. Jerks are sluggish. Some regains consciousness and some falls asleep immediately after attack. This sleep may continue for hours.
  • Post-epileptic automatism- some develops this after an attack and may do some unsocial work, e.g. undressing, stealing things etc.
  • Todd’s paralysis- This may occur after convulsion due to exhaustion of cerebral neurons and may last as long as 24 hours. Usually monoplegia occurs (rarely hemiplegia).
  • Aura – A group of symptoms immediately precede convulsions, e.g. psychic, visual, auditory, olfactory, gustatory hallucinations or peculiar epigastric sensation. Child becomes afraid of something going to happen soon and runs towards mother’s lap.
  • Tonic- lasts for about a minute. Whole body becomes stiff, respiration ceases, deep cyanosis, venous engorgement, sudden contraction of respiratory and glottis muscles produced “Epileptic cry”.

When attacks of the grand mal epilepsy occur successively without any intervening period of consciousness or remission the condition is known as Status Epilepticus. If this is condition is known as Status Epilepticus. If this is continued for long time patient gets exhausted and may die out of circulatory failure.

Investigations of Epilepsy :

  1. Pneumo-encephalography.
  2. Cerebral angiography.
  3. Electro-encephalography.
  4. E-Ray skull.

Differential Diagnosis :

  • Psychotic states.
  • Coma due to any cause.
  • Spasmus natans.
  • Pavor nocturnes.

Ques. 5     What is the treatment of epilepsy?

Ans.          Treatment :

  1. Diazepam 5-10 mg should be given slowly intravenously till the fits subside.
  2. Chemotheraphy (symptomatic treatment).
  3. Epileptics should observe a regular, quiet mode of life, avoid all excitement or overexertion. Out-door exercise, suitable clothing frequent ablutions, friction of the skin, regular habits & mental quietude.
  4. The care of the patient comprises social and psychological as well as pharmacological aspects.
  5. Place the patient in prone position, on a soft surface, avoid forcible restraint. Put an object such as hand-kerchief between the teeth to avoid tongue biting.
  6. Homoeopathic remedies.

Ques. 6     Which Homoeopathic Remedies are useful?

Ans.          The Homoeopathic Remedies which are useful are :-

  • OPIUM- Spasms begin with loud screams, then foam at mouth, trembling of limbs and suffocation. Eyes half open and turned up pupils dilated and insensible to light. After attacks deep, face red and hot.
  • BELLADONNA- Recent cases, with decided brain symptoms. Illusions of sight and hearing. Convulsion commence in upper extremities and extend to mouth, fauces & eyes. Foam at mouth. Involuntary micturition and defecation.
  • BUFO – Epilepsy following onanism. Attacks occur mostly at change of the moon, at time of menses, in sleep. Painful weariness of limbs.
  • HYOSCYAMUS – Epilepsy preceded by vertigo, sparks, before the eyes, ringing in ears, hungry gnawing, During attack face purple, eyes projectin, shrieks, grinding teeth; urination, After attack, spoor, snoring.

Ques. 7     Which Biochemic Remedies are useful?

Ans.          The Biochemic Remedies are useful are :-

  • PHOS. – Epileptic fits, sometimes the results of vicious habits, which must be restrained.
  • SILICEA – Nocturnal epilepsy, esp. about the time of the new moon; feeling of coldness before the attack, spasms spreads from from the solar plexus upward. Exalted susceptibility to nervous stimuli, with exhausted condition of the nerves.
  • FERRUM PHOS. – Epileptic fits with rush of blood to head.
  • KALI PHOS – Epilepsy or epileptic fits with shrunken countenance, coldness and palpitation after the fit.

Differential Diagnosis :

 

Points

Epilepsy

Syncope

1)

Onset :

Rapid.

Slow.

2)

Duration :

Longer,

Shorter.

3)

Warning symptoms :

Epigastric or psychic arura; may be none.

Light headedness blurring of vision

4)

Posture during onset :

Any.

Usually upright.

5)

Pulse & blood pressure :

Raised.

Low.

6)

Injuries & incontinence :

Common.

Rare.

7)

Recovery :

Slow.

Prompt.

8)

After attacks :

Drowsiness, headache, and mental confusion.

Generalised physical weakness,

9)

Repeated attacks :

Common.

Rare.

 

Points

Hystericl Fit

Epilepsy

1)

Provoking stimulus :

Emotional upset.

None.

2)

Type of convulsion :

Irregular & bizarre type, usually occur in presence of others, no unconsciousness no spasms.

Definite sequence of unconscious-sness. Spasm and clonic movement. 

3)

Corneal reflex :

Evokes vigorous contraction of the ocular & facial muscles.

Absent.

4)

Planter response :

Flexor.

Extensor.

5)

Tongue bitting & incontinence :

None.

Common.

6)

Recovery :

Sudden.

Gradual.

 

 

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