Effectiveness of homoeopathy in the management of spastic cerebral palsy with global developmental delay – a case report
Abstract: Cerebral palsy is a common cause of chronic motor disability in children. It presents as global mental and physical dysfunction or isolated gait, cognition, growth, or sensation. This group of patients will have to be dependent on others during adulthood and require long-term on-going care. Here we are discussing a case of Cerebral palsy which has improvement in quality of life and motor activities with an indicated individualized Homoeopathic medicine.
Key words: Cerebral palsy, Individualized homoeopathic medicine.
Cerebral palsy is described as, ‘a group of permanent disorders of movements and posture, causing limitation of activity attributable to non -progressive disturbances that occurred in the developing fetal or infant brain, often accompanied by disturbances of sensation, perception, cognition, communication and behavior, epilepsy and secondary musculoskeletal problems. The birth prevalence of CP ranging from 1.5 to more than 4 per 1000 live births.1 Prematurity and low birthweight are important risk factors for CP. Main pathological findings seen in preterm infant who develop CP are, the initial injury to the brain occurs during early fetal brain development , intracerebral hemorrhage and periventricular leukomalacia.2 Early markers of cerebral palsy are bilirubin encephalopathy, Hypoxic ischemic encephalopathy , Persistence moro, tonic neck and other primitive reflexes after the age of 3 months.3
The treatment needs to be depended on the degree of functional failure caused by the spasticity and its location. This management often requires a variety of different approaches including oral medications, occupational and physical therapy and often surgical interventions such as selective dorsal rhizotomy and orthopedic surgery.5
As cerebral palsy is considered to be non-curable, the focus is on holistic management of CP, integrating the processes of diagnosis, dynamic assessment of the status of disabilities and Individual homoeopathic intervention and patient care and support.
Here we are discussing a case of Cerebral palsy with ongoing treatment of homoeopathy which showed marked improvement in motor functioning and Quality of life of a child.
An 8-year-old girl child reported with complaints of not able to sit, stand, crawl, walk and not able to speak. And was diagnosed to have Spastic Quadriparesis Cerebral Palsy.
HISTORY OF CHIEF COMPLAINT
Mother complaints of child not being able sit, walk, and talk. All her milestones were also delayed, achieved neck holding at the age of 8 months, Rolling over at 1 year. sitting with support since a year. Not able to sit without support, cannot stand even with support. There is no eye to eye contact. Cannot fix eyes at one point, constantly follows objects. Also, Constant drooling of saliva present since birth. Startles at any noise since birth. No speech at all. She only startles at any loud noise. Unable to chew the food, has to be given in liquid form with spoon otherwise it spills out. Presently she is on acupuncture therapy.
H/O seizures since birth, (Used to get daily 4 to 5 attacks) which stopped after acupuncture therapy (since a year).
TREATMENT HISTORY – Taken allopathic medicine for the presenting complaints for 7 years. Stopped since a year.
Physiotherapy was done for 3 years.
No surgical history
ALLERGIC HISTORY – not allergic to dust drug and diet.
BIRTH AND DEVELOPMENTAL HISTORY
Planned pregnancy, non-consanguineous marriage Born at full term.
2.98 kgs, HC-34 cms, Length – 50 cms.
Did not cry immediately after birth, was resuscitated and administered oxygen for 2 days. Was in NICU for 15 days Baby as was cyanosed, no spontaneous breathing, Poor perfusion and Low pulse volume. Hypotonic convulsion at birth.
Breast feeding started after a month but baby had difficulty in suckling, so switched to spoon feeding.
Perinatal hypoxia stage 2
CT SCAN OF BRAIN (PLAIN)
- Cystic encephalomalacia in left fronto-temporo-parietal lobes.
- Calcified densities in right frontal and bilateral parietal lobes
- Chronic subdural collection along left fronto- parietal convexity
- Cerebral atrophy.
- Features are suggestive of sequalae of hypoxic ischaemic insult/perinatal injections.
OBSTETRIC AND ANTEBATAL HISTORY OF MOTHER
- Adequate antenatal care recieved
- There was no hyperemesis, no major illness like Hypertension, diabetes during pregnancy.
- Tetanus injections taken: 1st dose at 4th month & 2nd dose at 5th month.
- Anomaly scan done at 5th month with no abnormality. But complicated at full term with fetal distress during labor
- At labor- Premature rupture of membrane (PROM) for 4 to 5 hours, tried forceps delivery but failed. LSCS was done
- She had subsequent pregnancy after 2 years with 2 spontaneous abortions, now seeking treatment for secondary infertility.
- Maternal grandmother – Hypertension & Primary Osteoarthritis of B/L knee joint.
- Mother – Hyperthyroidism. Allergic rhinitis.
- Maternal Aunt- Mental retardation.
- Maternal uncle died due to Cardiac arrest
- MGF- Died due to Renal failure.
- PGF- DM & HTN, Cardiovascular Accident and bedridden
- PGM- HTN & DM.
- APPETITE – Reduced
- THIRST- Decreased
- DESIRE – nothing significant
- AVERSION – nothing significant
- BOWEL HABITS – Once per days, no difficulties.
- BLADDER HABITS – Regular, but cannot understand the urge.
- SLEEP – Reduced, Sleeps for 4 to 5 hours, Irregular pattern.
- DREAM – Nothing specific
- PERSPIRATION –Absent
- THERMALS – Chilly
LIFE SPACE INVESTIGATION
Mental generals- Anger she bites herself with anger,
weeps when she hears loud noise.
wants to be alone
On observation – no eye contact,
GENERAL PHYSICAL EXAMINATION
- Built and nourishment – well built & well nourished
- Weight – 49 kgs
- Height- 113cms
- Scalp – Healthy
- Eyes – conjunctiva – pink, sclera –clear SQUINT eyes
- Ears – NAD
- Nose– no DNS
- Mouth – buccal mucosa – pink, tongue- clean and moist
- hygiene well maintained, constant drooling of saliva.
- Neck- no lymphadenopathy
- Nails- Normal
- Temperature – afebrile at the time examination.
- Pulse – 92 beats/minute.
- regular rhythm,moderate volume, no vessel wall palpable
- Resp rate –22breaths/ minute.
- Inspection- no abnormality
- Palpation- trachea centrally placed.
- Percussion- resonant note
- Auscultation- Normal vesicular breath sound
No added sound
- Inspection– distention present
- palpation– no rigidity, no tenderness, no organomegaly.
- Percussion– tympanic
- Auscultation– bowel sound normal
Cardio vascular system – S1 S2 heard, normal; no murmur
CNS – Higher mental function test :Conscious,
- Appearance: child appears to be disabled
- Not oriented with time, place and person.
- Not attentive
- No speech and language developed.
- Memory- could not elicit
Cranial nerve examination- could not elicit
Motor system examination
Inspection: no visible fasciculation, grimaces, abnormal expression.
Superficial reflexes- plantar reflex (babinski sign)- positive,
Corneal reflex, conjunctival reflex and abdominal reflex, nasal reflex- exaggerated
Deep reflex- exaggerated
- Abnormal movements: startles
- Sensory system:
- Touch: normal
- Pain: grimaces
- Temperature: not elicited
- Proprioception: not elicited
- Dysdiadokinesia: not elicited
- The following symptoms were considered for the totality
- Mind, biting
- Mind, company-aversion
- Mind, starting- noise from
- Sleep – Sleeplessness
- Generals- convulsion
- Generals- development, arrested
- Which yielded in the following reportorial result
- Natrum Muriaticum -14/6
- Calcarean – 13/6
- Baryta carb- 10/6
- Buforana – 10/6
- Causticum- 10/6
Based on the case, Baryta carb was prescribed to her(6,7)
25/1/2022 : Baryta carb 1M/ 1dose
23/2/2022: sleep better for about 10 hours sound sleep,
Rest of the complaints same.
BARYTA CARB 1M/1dose PLUSSING POTENCY
PL BD / 15 days
10/3/2022: Generals good
- Anger reduced, weeps when kids of her age talks to her, but not when her parents.
- Started swallowing, masticating semisolid food.
- Sleep is good, sound for 10-12 hours
7/4/2022: C/O swelling of left eye
- Agglutination of eye in the morning present
- Rubbing of eye, redness present.
- Eye contact slight better.
- Other complaints same
15/06/2022: Does understand the surrounding, chewing movements better, started with solid food. Swallowing better with minimal spillage, Sitting with support for 20-30 minutes.
- Doesn’t let her mother carry any other kids
- Weeping increased,
- Constantly asks for bath in a day 4 to 5 times, if not given constantly cries.
- Sleep is good- sound sleep for 10 hours.
- Anger increased, bites herself specially when she is unable to express what she needs.
- Weeping persists, asking for bathing is same.
- Chewing movements better
- No further change in her motor development
- No fresh complaints.
- Baryta carb 1M/ 1dose & PL TID / 1MONTH
- Weakness better, weeping reduced, Anger reduced, Sleep well,
- Generals are good
RESULT AND CONCLUSION:
Children with Cerebral palsy are dependent, and are unable to lead a independent life in adulthood needing long term care, Its becomes the difficult task to provide good quality of life to such patient.
In our case after detailed case history, examination and investigation reports, with the help of repertory and Materia Medica Baryta carb was prescribed. Which showed the efficient results in improving the motor performance and cognition of a child with spastic quadriparesis CP with Global developmental delay
Limitation: Major limitation is that it’s a single case study, and the study duration for the conclusion. So, its required to have more controlled trails in this area to show evidence of Homeopathic role in treatment of Cerebral palsy.
Conflict of interest: None
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Government Homoeopathic Medical College and Hospital