Epilepsy. – Dr. Sayeed Ahmad

Index

Epilepsy.
Dr. Sayeed Ahmad D.
I. Hom. (London)

I

–
INTRODUCTION

Epilepsy, also called seizure disorder, chronic brain
disorder that briefly interrupts the normal electrical activity of the
brain to cause seizures, characterized by a variety of symptoms
including uncontrolled movements of the body, disorientation or
confusion, sudden fear, or loss of consciousness. Epilepsy may result
from a head injury, stroke, brain tumor, lead poisoning, genetic
conditions, or severe infections like meningitis or encephalitis. In
over 70 percent of cases no cause for epilepsy is identified. Some 40 to
50 million people suffer from epilepsy worldwide and the majority of
cases are in developing countries. According to the World Health
Organization (WHO), an estimated 2 million new cases are diagnosed each
year globally.

II

–
TYPES OF SEIZURES

Epileptic seizures vary in intensity and symptoms
depending on what part of the brain is involved. In partial seizures,
the most common form of seizure in adults, only one area of the brain is
involved. Partial seizures are classified as simple partial, complex
partial (also known as psychomotor), and absence (also known as
myoclonic or petit mal) seizures.

People who have simple partial seizures may
experience unusual sensations such as uncontrollable jerky motions of a
body part, sight or hearing impairment, sudden sweating or flushing,
nausea, and feelings of fear.

Complex partial seizures, also called temporal lobe
epilepsy, last for only one or two minutes. The individual may appear to
be in a trance and moves randomly with no control over body movements.
The individual’s activity does not cease during the seizure, but
behavior is random and totally unrelated to the individual’s
surroundings. This form of seizure may be preceded by an aura (a warning
sensation characterized by feelings of fear, abdominal discomfort,
dizziness, or strange odors and sensations).

Absence seizures, rare in adults, are characterized
by a sudden, momentary loss or impairment of consciousness. Overt
symptoms are often as slight as an upward staring of the eyes, a
staggering gait, or a twitching of the facial muscles. No aura occurs
and the person often resumes activity without realizing that the seizure
has occurred.

In a second type of epilepsy, known as generalized
seizure, tonic clonic, grand mal, or convulsion, the whole brain is
involved. This type of seizure is often signaled by an involuntary
scream, caused by contraction of the muscles that control breathing. As
loss of consciousness sets in, the entire body is gripped by a jerking
muscular contraction. The face reddens, breathing stops, and the back
arches. Subsequently, alternate contractions and relaxations of the
muscles throw the body into sometimes violent agitation such that the
person may be subject to serious injury. After the convulsion subsides,
the person is exhausted and may sleep heavily. Confusion, nausea, and
sore muscles are often experienced upon awakening, and the individual
may have no memory of the seizure. Attacks occur at varying intervals,
in some people as seldom as once a year and in others as frequently as
several times a day. About 8 percent of those subject to generalized
seizures may have status epilepticus, in which seizures occur
successively with no intervening periods of consciousness. These attacks
may be fatal unless treated promptly with the drug diazepam.

III

–
DIAGNOSIS

In persons suffering from epilepsy, the brain
waves, electrical activity in the part of the brain called the
cerebral cortex, have a characteristically abnormal rhythm produced by
excessive electrical discharges in the nerve cells. Because these wave
patterns differ markedly according to their specific source, a recording
of the brain waves, known as an electroencephalogram (EEG) is important
in the diagnosis and study of the disorder. Diagnosis also requires a
thorough medical history describing seizure characteristics and
frequency.

IV

–
TREATMENT

There is no cure for epilepsy but symptoms of the
disorder may be treated with drugs, surgery, or a special diet. Drug
therapy is the most common treatment-seizures can be prevented or their
frequency lessened in 80 to 85 percent of cases by drugs known as
anticonvulsants or antiepileptics. Surgery is used when drug treatments
fail and the brain tissue causing the seizures is confined to one area
and can safely be removed. A special high-fat diet known as a ketogenic
diet produces a chemical condition in the body called ketosis that helps
prevent seizures in young children. Like any medical condition, epilepsy
is affected by general health. Regular exercise, plenty of rest, and
efforts to reduce stress can all have a positive effect on a person with
a seizure disorder.

First aid for generalized seizures involves
protecting the individual by clearing the area of sharp or hard objects,
providing soft cushioning for the head, such as a pillow or folded
jacket and, if necessary, turning the individual on the side to keep his
or her airway clear. The individual having a seizure should not be
restrained and the mouth should not be forced open-it is not true that a
person having a seizure can swallow the tongue. If the individual having
the seizure is known to have epilepsy or is wearing epilepsy
identification jewelry, an ambulance should only be called if the
seizure lasts longer than five minutes, another seizure closely follows
the first, or the person cannot be awakened after the jerking movements
subside.

ANTI-EPILEPTIC ALLOPATHIC DRUGS

TEGRETOL Carbamazepine

This is a powerful anti-epileptic drug with a wide
range of activity. It is available as white tablets of two strengths
(100 mg and 200 mg), and is usually given twice a day (say after
breakfast, and then after the evening meal, around 12 hours later). An
average sized adult usually requires between one and two tablets (200 mg
size, twice a day).

If the dose is too high, the patient may appear to be
“drunk”, with drowsiness, lack of co-ordination in walking,
etc. Reduction of the dose, based on blood levels, is all that is
required.

Side effects (unwanted symptoms occurring in someone
whose levels are correct) are common in the first few days or week or
two, especially giddiness and light headedness, mild nausea, and dryness
of the mouth. These usually disappear within a few days. They are less
likely to occur if Tegretol is introduced in a gradual way. A
measles-like rash sometimes occurs during Tegretol treatment, and in
this event, Tegretol must be replaced by another anti-epileptic drug.
Serious side effects are fortunately rare. They include jaundice due to
liver involvement, and lowering of the white cell count of the blood,
resulting in persistent ulceration of the throat and mouth.

The manufacturers recommend that blood tests (full
blood count, tests of liver and kidney function) be carried out before
starting Tegretol, and that the full blood count be repeated weekly for
the first month of treatment, then monthly for the first year.

In practice, Tegretol side effects are usually mild,
and disappear within the first week or two. It is arguably the most
powerful and useful anti-epileptic drug currently available.

EPILIM Sodium valproate

This is another extremely useful drug with a wide
range of anti-epileptic activity. It is thought to act by increasing the
brain’s levels of the inhibitory neurotransmitter, GABA.

Epilim is presented as lilac colored tablets of 200
mg and 500 mg strength. These should be swallowed whole. It is also
available as crushable tablets of 100 mg strength, and as syrup of 200
mg/5ml strength, and sugar free liquid of similar strength.

It is usual to give Epilim twice a day, with meals,
with roughly 12 hours between doses. Since blood levels of Epilim are
unreliable as a guide, adjustment of the dosage is made according to the
patient’s body weight, and the adequacy of seizure control. The usual
dose range is 20 to 30 mg/kg body weight/24 hours.

Mild side effects, especially nausea and diarrhea in
the first few days, are common. A fine tremor of the hands is often
noticed in patients taking Epilim over the long term. Weight gain and
loss of hair (usually reversible) can also occur.

Very rarely, Epilim may produce acute liver disease,
and there have been instances of acute liver failure, some fatal. Small
children and infants with serious underlying medical conditions are most
at risk. The question of the safety of Epilim has received careful study
by Australian health authorities, and its continued use has been
endorsed, for it is in practice a widely used, effective, and well
tolerated medication.

It is suggested that Epilim be avoided in patients
with a history of liver disease, and that blood tests to check liver
function and the level of platelets in the blood (sometimes reduced by
Epilim) be carried out before starting treatment, and repeated after one
month’s treatment, and thereafter at intervals of not more than 6
months. Minor abnormalities of liver function are common in patients
taking most anti-epileptic drugs, but evidence of increasing abnormality
would require substitution of Epilim.

Symptoms of this rare complication of liver failure
include severe nausea persistent abnormal pain, jaundice (yellowish
discoloration of the skin), severe nausea, weakness and tiredness, and
swelling of the face. Any of these symptoms should be reported to the
treating doctor.

DILANTIN Phenytoin sodium

This is the oldest of the effective major
anti-epileptic drugs. It is still one of the most potent in preventing
major seizures of tonic-clonic and other types, but its troublesome side
effects have meant that the other, newer drugs such as Tegretol and
Epilim are usually selected instead. Dilantin has a powerful action in
controlling seizures, and is very useful as an additional drug where
seizures cannot be controlled by one drug alone, or when it is not
intended to continue treatment over a very long period (for example,
when anti-epileptic drugs are given routinely for a year or two after
brain surgery).

Dilantin is presented in capsule form (100mg, orange
and white capsules, 30mg, all white capsules), in liquid form (30 mg/5ml
strength for children, 100 mg/5ml. “Dilantin Forte Suspension”
for adults), and as chewable tablets for children (50 mg,
“Infatabs”)

The drug is slowly released, so that theoretically it
would be possible to take the medication as a dingle daily dose;
however, people’s memories being what they are, it is recommended that
the medication be taken twice a day (e. g. after breakfast, and after
the evening meal as a routine). The usual dose for an adult of average
size is 3 to 4 capsules of 100 mg strength per 24 hours.

Dilantin overdose produces symptoms similar to
drunkenness, with drowsiness, unsteadiness on the feet, etc. Blood
levels of Dilantin will indicate the true picture.

Short term side effects of Dilantin are not usually a
problem, but side effects developing gradually over a period of years do
present serious objections to its long term use, especially as other
effective anti-epileptic drugs which do not have these problems are now
available. These long-term side effects of Dilantin are the growth of
hair on the face, arms and legs, especially in female patients of dark
complexion, unhealthy overgrowth of the gums, with a tendency for them
to bleed, and mental sluggishness and loss of memory.

If Dilantin is to be taken over a long period,
special attention should be paid to brushing the teeth and generally
maintaining good oral hygiene. An uncommon complication of Dilantin
therapy is the development of an allergic measles like rash, which
requires substitution of the drug with another.

ZARONTIN Ethisyxunudem

This drug is effective in controlling one form of
epilepsy only, namely absence seizures (formerly known as “petit
mal”). As this form of epilepsy begins in childhood, Zarontin is
made available as a red syrup (250 mg/5 ml) and as capsules (250 mg).
The dose required will vary according to blood levels and body weight,
the average dose for a child aged 6 years being one capsule, 2 or 3
times a day.

Side effects are not common, but include nausea and
digestive upset, drowsiness and sleep disturbance.

Benzodiazepine Drugs

These drugs have sedative and anti-anxiety properties
as well as being anti-epileptic. They are in fact only fairly week drugs
against epilepsy, while their tendency to produce sedation and
dependency greatly limit their usefulness. In practice, these drugs
should never be used as a first choice, but rather reserved for those
situations where epilepsy remains uncontrolled despite treatment with
adequate doses of other anti-epileptic drugs.

The benzodiazepine drugs include:

RIVOTRIL (Clonazepam).
FRISIUM (Clobazepam).
VALIUM (Diazepam).
MOGODON (Nitrazepam).

The main side effects of these drugs are sedation and
drowsiness in the daytime. There is a risk of producing drug dependency.
Also, patients may experience various unpleasant side effects, such as
restlessness, sleep disturbances, etc. when these drugs are withdrawn
after a long period of administration.

Barbiturate Drugs

These drugs were widely used in the 1950’s and
1960’s, but are now considered to be obsolete. They are not very
effective in suppressing seizures, but they frequently cause slowing of
the intellect and depression. Withdrawing these medications can be
extremely traumatic, with anxiety, restlessness, tremors, insomnia, and
an increased risk of convulsions being prominent as the drug leaves the
system.

An effort should be made to change every patient
still taking these drugs over to one of the newer anti-epileptic
medications, difficult as this might be.

Barbiturate anti-epileptic drugs still available
include:

PROMINAL (Methylphenobarbitone).
MYSOLINE (Primidone).
PHENOBARBITONE.

Other Drugs

OSPOLOT (Sulthiame, Bayer Pharmaceuticals)

This drug may have a special value in controlling
epilepsy in intellectually disabled, aggressive children. It is not a
very effective anti-epileptic, and is not widely used.

The Newest Anti-epileptic Drugs

These drugs are the outcome of research aimed at
suppressing seizures by either increasing inhibition (through enhancing
the activity of the natural inhibitory neurotransmitter GABA, or
simulating its action); or, alternatively, reducing the effectiveness of
natural excitatory neurotransmitters, such as glutamate.

HOMŒOPATHIC TREATMENT

Calcarea carbonica.

The treatment of epilepsy should be directed to the
underlying dyscrasia, as this is at fault in most, if not all, cases.
Calcarea carbonica, with its rickety, tuberculous, scrofulous and flabby
symptoms, its characteristic deficiency of lime assimilation, as shown
in children by the open fontanelles and backward dentition, will
frequently be the remedy with which to commence the treatment. The
characteristic relaxation on falling asleep and the sweating of the head
and neck are fine indications for its use. It has an excellent clinical
record. A epileptic suffering continually from the dread of an attack
will withdraw himself as much as possible from the outside world, brood
over his affliction and become melancholic, and there is no other remedy
so well adapted to this condition as Calcarea. Its anxiety, palpitation,
apprehensive mood despondency, fretfulness and irritability, its
weakness of memory, its loss of consciousness, its vertigo and
convulsions are prominent and characteristic indications for its use in
epilepsy. If epilepsy be caused by fright, suppression of some long
standing eruption, onanism or venereal excess it will probably be one of
the remedies to use in the course of the treatment, and here it would
follow Sulphur well. The aura may begin in the solar plexus and pass
upwards like a wave, or go from the epigastric region down to the uterus
and limbs. Like Sulphur it has a sensation as if a mouse were running up
the arm previous to the attacks.

Causticum, too, is closely allied to Calcarea, and is
indicated in epilepsy connected with menstrual irregularities and also
in epilepsy occurring at the age of puberty.

Bufo rana.

Epilepsy arising from fright, or self-abuse, or
sexual excesses, will often find its remedy in Bufo rana. The aura
preceding the attacks starts from the genital organs; even during coitus
the patient may be seized with violent convulsions. In another form for
which Bufo is suitable the aura starts from the solar plexus. Previous
to the attacks, the patient is very irritable, often talks incoherently
and is easily angered. It is especially in the sexual form, that brought
on by masturbation, that Bufo is signally useful. It has also proved
useful in severe cases in children where the head in the convulsion is
drawn backwards. Indigo has epileptiform convulsions from the irritation
of worms, but the patient must be low-spirited and sad– “blue as
indigo.” It is the “bluest remedy in the materia medica.”
Dr. Colby, of Boston, considers it superior to the bromides. Flushes of
heat seem to rise from the solar plexus to the head and there is an
undulating sensation in the brain similar to Cimicifuga. Bufo, like Nux
vomica, is vehement and irritable. These two remedies and Silicea and
Calcarea have the aura starting from the solar plexus. Stannum is also a
remedy for epilepsy arising from reflex irritation, as from worms and
also from sexual complications.

Cuprum Metallicum.

Cuprum is a very deep-acting remedy, its well-known
power of producing convulsions and spasms and its excellent clinical
record make it a valuable remedy in epilepsy. We know positively that
poisonous doses of Cuprum cause epileptic symptoms, and it is among the
most curative remedies for epilepsy in child life. The convulsions start
form the brain, though the aura, which is one of long duration, seems to
center in the epigastrium. Owing to this long duration of the aura
consciousness is not immediately lost, and the patient will often notice
the contractions in the fingers and toes before they become unconscious.
The face and lips are very blue, the eyeballs are rotated, there is
frothing at the mouth and violent contractions of the flexors. The
attacks is usually ushered in by a shrill cry and the cases are most
violent and continued. It is also a remedy for nocturnal epilepsy when
the fits occur at regular intervals, such as the menstrual periods.
Epileptiform spasms during dentition or from retrocessed exanthema may
indicate Cuprum. Dr. Halbert remarks that Cuprum will stop the frequency
of the attacks more satisfactorily than any other remedy, it is his
sheet anchor in old and obstinate cases.

Butler also claims his best results from this remedy.
Argentum nitricum is also a remedy for epilepsy, the strong indicating
features being the dilated pupils four or five days before the attack,
and the restlessness and trembling of the hands after the attack.
Menstrual and fright epilepsies often call for this remedy the
characteristic being the aura, which lasts a number of hours before the
attack. Moral causes may lead to an attack. Patient is low spirited,
easily discouraged and frightened.

Œnanthe crocata.

Perhaps no remedy in the materia medica more closely
pictures epilepsy than Œnanthe. Its use in the disease has been mainly
from clinical data, but there is ample proof from studying toxic cases
that it is homœopathic to many cases of epilepsy. The reliable and
practical symptoms calling for its use may be summed up as follows:
Sudden and complete loss of consciousness; swollen livid face; frothing
at the mouth; dilated or irregular pupils; convulsions with locked jaws
and cold exremities. Dr. S. H. Talcott, of the Middletown State
Hospital, summed up his experience with the remedy as follows:

1. The fits decrease in number 40 to 50 per cent.

2. The convulsion are less severe than formerly.

3. There is less maniacal excitement before the
fits.

4. Less sleeplessness, stupor and apathy after the
fits and

the debilitating effects of the attacks are more
quickly recovered from.

5. The patients treated with Œnanthe are less
irritable, less suspicious and less fault finding.

6. The patients are more easily cared for.

The writer can add his testimony to the effect of
Œnanthe in controlling attacks of epilepsy. It seems to act better in
the 3X or 6X potency than in the tincture. Cases of cure of the disease
are becoming more numerous. Artemisia vulgaris is another remedy which
has been successfully used for epilepsy from fright or some mental
emotion, where the attacks occur in rapid succession, and also in petit
mal, where the patient is unconscious only for a few seconds and then
resumes his occupation as if nothing had happened. Artemisia absinthium
indicated in seizures preceded by vertigo, a warm sensation rising from
the stomach, and by a slight impairment

of speech, and Solanum Carolinense are also remedies
which in some cases have wrought cures, the latter according to

Dr. Halbert, of Chicago, also praises it. Melancholia
seems to be an indication and also attacks appearing at menstrual
periods. Verbena hastata is also recommended, but no special indications
are to be found.

Kali bromatum.

This remedy should have no place in the homœopathic
treatment of epilepsy; it is given here because it is the principal drug
employed by the allopathic school, and because nearly all cases coming
to us for treatment from old school hands are liable to be complicated
by a previous treatment with the bromides, notable the Bromide of
Potash. It is not a curative remedy, but a palliative one; it strikes at
the attack and not the disease. It will often modify the attacks, and
used as a prophylactic may avert the seizure, but its prolonged use
works inevitable harm. It weakens the mental faculties and hastens
imbecility. Camphora is useful to prevent the attacks, shorten the
duration and lessen the intensity. It is indicated by all the
characteristic of epilepsy and hence is a safer prophylactic than the
Bromide of potash. Camphora, Nux vomica and Zincum are mentioned as
antidotes for the abuse of the Bromide of Potash. Bromide acne is often
present in cases coming to us from old school hands.

Silicea.

Silicea is one of our most valuable remedies in
epilepsy. It suits especially scrofulous and rickety subjects. The aura
starts from the solar plexus, as in Bufo and Nux vomica. Certain phases
of the moon are said to affect the attacks, which are brought on by an
overstrain of the mind or emotions. Nocturnal epilepsy, feeling of
coldness before an attacks is also characteristic of the drug, and the
fit is followed by warm perspiration. Cuprum is also a remedy for
nocturnal epilepsy and must be thought of when attacks invariably occur
in the night. When Silicea is required there is an exalted
susceptibility of the upper spinal cord and the medulla and an exhausted
condition of the nerves. The attacks occur about the time of the new
moon. It comes in after Calcarea in inveterate chronic cases, and
coldness of the left side of the body preceding the attack is very
characteristic.

Nux vomica.

The characterizing feature of epilepsy is loss of
consciousness, therefore, Nux vomica is not often a remedy in the
idiopathic form. It suits cases arising from an excess of the reflex
action caused, for instance, by indigestion. The aura in a case calling
for Nux starts in the solar plexus, and among the most characteristic
symptoms is a sensation of ants crawling over the face. The middle and
higher potencies will be found more useful in the spinal form of
epilepsy, and this is the form most suitable to Nux. Plumbum has caused
epilepsy, and we may use it for these symptoms: the attack is preceded
by a heaviness of the legs and is followed by paralysis; epileptic
seizures from sclerosis, or from tumors of the brain, consciousness
returning slowly after an attack is another indication and it is more
suitable to the chronic forms of the disease. Constipation and abdominal
pains further indicate. Secale is recommended for sudden and rapidly
recurring convulsions, with rapid sinking of strength and paralysis of
the spinal nerves.

Cicuta virosa.

The indications for cicuta are sudden rigidity
followed by jerks and violent distortions, and these followed by utter
prostration. The prostration is characteristic, being equaled only by
that of Chininum arsenicosum. There is

a tonic spasm renewed by touch simulating Strychnia;
but in Cicuta there is loss of consciousness, thus resembling more the
epileptiform. There is great oppression of breathing, lockjaw, face dark
red, frothing at the mouth and opisthotonos. The reflex excitability
under Cicuta is much less than under Strychnia. Another characteristic
of Cicuta is fixed staring eyes; others are trembling before and after
the spasm and strange feeling in the head preceding the attack. Bayes,
however, regards muscular convulsions as a specially prominent symptom
for Cuprum.

Sulphur

Like Calcarea, Sulphur is a constitutional or basic
remedy, and it will act well where there is a scrofulous taint. It is
useful for the same class of cases as is Calcarea; namely, those brought
on by sexual excesses or the suppression of some eruption. The
convulsions are attended with great exhaustion and it is suitable to the
chronic form of epilepsy in children who are typical Sulphur patients.
There is perhaps a tendency to fall to the left side. Sulphur is also a
useful intercurrent remedy in the course of the treatment of an
epilepsy. Psorinum may also be needed as an intercurrent.

Hyoscyamus

In epileptic convulsions Hyoscyamus is a most
valuable remedy. There is much twitching and jerking and hunger previous
to the attack, there is frothing at the mouth and biting of the tongue.
A violent fright will produce an attack that will call for Hyoscyamus.
The convulsions seem to have more of a hysterical nature, and there are
illusions of sight and hearing. Stramonium has epilepsy from fright,
sudden loss of consciousness and jerking of the head to the right, with
rotary motion of the left arm. Stramonium is the opposite of Belladonna,
for whereas the Belladonna patient shuns light, fears noises and is
sensitive in the highest degree, the Stramonium patient fears darkness
and hates to be alone; he acts like a coward and trembles and shakes.
Agaricus 30 cured a case of epilepsy of 22 years’ standing for Dr.
Winterburn. He was led to its prescription by the unusual symptom of
“great flow of ideas and loquacity after the attack.”

Belladonna

Belladonna is especially a remedy for acute
epilepsies, when the cerebral symptoms ar prominent, where the face is
flushed and the whole trouble seems to picture cerebral irritation, and
more especially if the patient be young. There is an aura as if a mouse
were running over an extremity, or of heat rising from the stomach.
There are illusions of sight and hearing, and the convulsions are apt to
commence in an upper extremity and extend to the mouth, face and eyes.
The great irritability of the nervous system, the easily disturbed
sleep, the startings, the tremors and twitching and the general
Belladonna symptoms will render the choice easy. Atropine, the alkaloid
of Belladonna, has also been used successfully in the treatment of
epilepsy. Hydrocyanic acid. Another remedy is Hydrocyanic acid, to which
Hughes ascribes specific powers in the disease. In recent cases it
perhaps our best remedy. the cases calling for it will be characterized
by loss of consciousness, clenched hands, set jaws, frothing at the
mouth, inability to swallow, and the attack is followed by great
drowsiness and prostration. Children are disinclined to play and take
but little interest in anything. It is one of our mainstays in epilepsy
and its clinical record ranks it high.

Causticum.

Causticum is useful in Petit mal, also when the
patient falls while walking in the open air, but soon recovers. It is
said to be useful when the attacks occur at new moon. It menstrual
epilepsy and that occurring at puberty Causticum is the remedy. Kafka
recommends Hepar in nocturnal epilepsy. Causticum is perhaps better
suited to recent and light cases. Another preparation of potash, Kali
muriaticum, is a most useful remedy in epilepsy; it has an affinity for
the nerve centers and it is a slow acting remedy.

Reference :

MS Encarta Encyclopedia 2002.

Copyright © Dr. Sayeed Ahmad
2004

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