Exploring the role of homoeopathy in epilepsy treatment and care

Dr Niyati Narendran

Abstract
Epilepsy is a disease of the brain characterised by an enduring predisposition to generate epileptic seizures. Epilepsy are the most common neurological problem encountered in children and are often a frightening experience for the parents or caretakers. It has deleterious effects on social, vocational, physical and psychological wellbeing.

Keywords: Children, Epilepsy, Homoeopathy, Management, Status epilepticus,

Introduction
An epileptic seizure be defined in as a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain. Epilepsy is not a single disease. It is a heterogeneous group of diseases of diverse etiologies. Epilepsy is a clinical diagnosis. There is no investigation that confirms the diagnosis of epilepsy.

Epidemiology
Occurs in approximately 0.5–1% of children worldwide. The overall incidence of childhood epilepsy is approximately 40 cases per 100,000 children per year in the developed countries. The highest incidence rate is observed in infancy with a peak in the first week of life with subsequent decline with age.

Physiology
The brain consists of nerve cells that communicate with each other through electrical activity. A seizure occurs when 1 or more parts of the brain has a burst of abnormal electrical signals that interrupts normal brain signals.

Causes
Anything that interrupts the normal connections between nerve cells in the brain can cause a seizure. This includes a high fever, high or low blood sugar, brain tumour, brain damage from illness, infection, or injury, including those at birth. But when a child has two or more seizures with no known cause, this is diagnosed as epilepsy.

Diagnosis of childhood epilepsy.
According to the current International League Against Epilepsy (ILAE) definition, a diagnosis of epilepsy can be made if a child has had at least 2 unprovoked epileptic seizures more than 24 hours apart in their life, one unprovoked epileptic seizure with a probability of having another seizure at risk after a second seizure within the next 10 years, or if a specific epileptic syndrome is diagnosed.

Classifications

The two main categories of epileptic seizures are

1. Focal (partial) seizure and
2. generalized seizure.

Subclassification of Generalized seizures are

1. Generalized tonic–clonic (GTCS): This is also called grand mal seizure. The classic form of this kind of seizure has 5 distinct phases. It starts with opening of eyes, tonic deviation of head and eyes followed by a tonic phase characterized by sustained contraction of all skeletal muscles. This phase may be characterized by forced closure of the mouth, tongue biting, epileptic cry and cyanosis. The tonic phase ends with a vibratory tremor usually involving distal and facial muscles. This is followed by clonic phase with continuous clonic jerks of facial, trunk and limb muscles. The recovery phase starts with the cessation of the clonic jerks and is characterized by unresponsiveness, bronchial secretions, urinary and rarely faecal incontinence. There is gradual recovery.
2. Myoclonic: It is a sudden brief (< 100 ms) involuntary shock-like contraction of muscle(s) or muscle groups of variable topography. They may be focal, segmental, multifocal or generalized.
3. Clonic: They are characterized by rhythmic clonic convulsions only.
4. Tonic: They are characterized by sustained muscular contractions (> 2 s) only without clonic components.
5. Atonic:
6. Absence: two types typical and atypical
7. Typical absences are brief seizures with abrupt onset and termination lasting for 5–20 s, usually occurring multiple times in a day. They are characterized by variable impairment of consciousness and associated with myoclonic components. Automatisms (lip licking, smacking, swallowing, fumbling with clothes, etc.) and autonomic disturbances are common.
8. Atypical absences are usually longer with inconspicuous onset and termination. The impairment in consciousness is usually variable and subtle with significant tone abnormalities and gradual postictal recovery. They usually occur in children with severe psychomotor retardation or learning disabilities and are accompanied by other seizure types.

Subclassifications of Focal seizures are

1. Simple: This a type of focal seizures where the patient retains awareness and responsiveness to the environmental cues appropriately. The seizure activity is limited to an isolated muscle group.
2. Complex: Child will likely have altered consciousness. Autonomic features may be in the form of pallor, sweating, flushing, increased or rarely decreased heart rate or change in respiration. Motor component may include focal tonic or dystonic posture or clonic jerking.

Status Epilepticus
Status epilepticus (SE) occurs when a seizure lasts more than 5 minutes or when seizures occur very close together and the person doesn’t recover consciousness between them. The most common causes of SE in children are fever and infections of the CNS. Other causes include hyponatremia, accidental ingestion of toxic agents, abnormalities of the CNS, genetic and metabolic disorders.

SE is a condition resulting either from the failure of the mechanisms responsible for seizure termination or from the initiation of mechanisms which lead to abnormally prolonged seizures. It is a condition that can have long-term consequences, including neuronal death, neuronal injury, and alteration of neuronal networks, depending on the type and duration of seizures.

Types of SE

1. Convulsive Status Epilepticus: can occur with prolonged tonic-clonic (also called convulsive or grand mal) seizures lasting longer than 5 minutes. It is also used for repeated tonic-clonic seizures without recovery of consciousness in between and lasting 5 minutes or longer. Gradually regain consciousness within 15 to 20 minutes. This type of status epilepticus is a medical emergency and can be life-threatening. Thus, requires immediate treatment by a medical team in a hospital setting.
2. Nonconvulsive Status Epilepticus: a single or repeated absence or focal impaired awareness seizures during which the person is not able to respond but is not displaying any movement or shaking of the body for longer than 10 minutes. This can begin as convulsive and then become nonconvulsive because of persistent seizures.  treatment should be started immediately.

Symptoms

• Staring
• Jerking movements of the arms and legs
• Stiffening of the body
• Loss of consciousness
• Breathing problems or stopping breathing
• Loss of bowel or bladder control
• Falling suddenly for no apparent reason, especially when associated with loss of consciousness
• Not responding to noise or words for brief periods
• Appearing confused or in a haze
• Nodding head rhythmically, when associated with loss of awareness or consciousness
• Periods of rapid eye blinking and staring

Role of EEG
When used judiciously, EEG is the single most useful tool in managing patients with epilepsy optimally. EEG can only support a clinical diagnosis of epilepsy when it is abnormal but cannot exclude epilepsy when it is normal. A patient with genetic trait has an epileptiform EEG but does not necessarily always manifest the disease. EEG abnormality may be seen in first degree relatives with epilepsy.

Management
The management of epilepsy is multidimensional and encompasses several issues centered on the child and the family than a mere act of prescribing medications. It involves a multifaceted approach aimed at controlling seizures, improving quality of life, and addressing any underlying causes.

The decision to treat or not to treat a patient with a single unprovoked seizure is controversial. Wait and watch policy is appropriate in most of the cases and treatment may be started after the second episode of seizure. By this approach, 50% of patients who are never going to have the second seizure are not unnecessarily treated.

A variety of treatment options such as antiepileptic drugs (AEDs), ketogenic diet, vagus nerve stimulation (VNS), and in some cases, surgical interventions can help control seizures and improve outcomes.

Treatment of a first unprovoked seizure must also include education and anticipatory guidance to patients and families.

Individualistic approach of Homoeopathy on epilepsy affected children is effective in the management of epilepsy as well as improvement in the quality of life.

• Cicuta: It is one of the best medicines for epilepsy where the attacks of convulsions are marked by violent, distorted body shape. The distortions are most frightful. There is present a marked opisthotonus. Convulsions occurring in children during dentition. Convulsions due to worms. Violent body distortions were seen. Touch and noise are the triggering factors.
• Artemisia Vulgaris: It is the best in case of Petit Mal Epilepsy especially in children. The main symptom is frequent brief episodes of seizures in a short time period. Ailments from strong emotions, including fear can cause convulsions. Absence of aura.
• Stramonium: It is the most suitable when the convulsion arises after exposure to bright light or shining objects. The consciousness is preserved and jerking of muscles of the upper body part.
• Belladonna: Convulsions during teething, with fever; comes on suddenly, head hot, feet cold rush of blood to head and face.
• Cuprum Met: It is the best suitable medicine when the seizure attack is preceded by an aura in the knee. The symptoms marked during the attack are clonic spasm that usually begins in finger or toes and soon covers the entire body. Jerking of muscles is also noticed. The Ailments from fright and anger can cause epilepsy.
• Staphysagria: Ailments from anger and humiliation, sexual passion, nervous excitability, sensitivity to insults. Ailments after indignation, grief, anger Nervous affections with marked irritability; violent outbursts of passion, hypochondriacal, sad.
• Bufo Rana: It is helpful in providing a cure for Epilepsy seizures where the attacks are present during sleep. The aura is felt in the genital area.

Conclusion
Epilepsy is a prevalent neurological disorder in children, characterized by recurrent, unprovoked seizures due to abnormal electrical activity in the brain. Early diagnosis and intervention are critical to minimizing the impact on a child’s development, quality of life, and cognitive function. Being holistic model of treatment, homoeopathy serves mankind without posing any risk of side effects and helps to prevent recurrence of epilepsy. Additionally, addressing psychosocial aspects of epilepsy, including the potential for stigma, anxiety, and educational challenges, is vital to ensure a holistic approach to care. Thus, children can lead fulfilling and productive lives.

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Dr Niyati Narendran 
MD scholar
UGO Dr. Jyoshna Shivaparasad, Professor and HOD, Department of Paediatrics, FMHMC, Mangalore.