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Table of Contents
CASE REPORTS
Year : 2019  |  Volume : 7  |  Issue : 4  |  Page : 245-248

Role of Ayurveda in the management of Apasmara: A case study


1 Department of Rachana Sharir, Mahatma Gandhi Ayurved College, Hospital and Research Centre, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharashtra, India
2 Department of Panchkarma, Mahatma Gandhi Ayurved College, Hospital and Research Centre, Datta Meghe Institute of Medical Sciences (DU), Wardha, Maharashtra, India

Date of Submission20-Dec-2019
Date of Decision22-Jan-2020
Date of Acceptance11-Feb-2020
Date of Web Publication14-Apr-2020

Correspondence Address:
Dr. Gaurav Sawarkar
Department of Rachana Sharir, Mahatma Gandhi Ayurved College, Hospital and Research Centre, Datta Meghe Institute of Medical Sciences (DU), Salod (Hirapur), Wardha 442001, Maharashtra.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISM.JISM_63_19

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  Abstract 

Apasmara (epilepsy) is defined by Acharya Charaka as Apagama (deterioration) of Smriti (retention) associated with Bibhatsa Chesta (seizers) due to derangement of Dhi and Sattva. The vitiate Dosha related to the condition are Vata and Rajo Dosha. The main features of Apasmara are impairment in memory or awareness. Even though most of the times, it is considered as Manasrogas (psychic disorders), it is not a Manasroga. Apasmara is one of the diseases, which affects both Sharira (physical) and Manas (mental). A 52-year-old man approached the OPD of Panchakarma department with the impairment of memory in the last 2 years. Earlier he had taken allopathic medicine but he discontinued the medicine due to no significant relief from the adverse effects of the medicines. He was advised with Yoga Basti (enema), Shirodhara (Pouring of medicated oil over head from a distant height), and Nasya (errhine therapy) along with palliative treatment. After 1-month treatment and follow-up, it was observed that the patient was satisfied with treatment and changes in the complaints with improved quality of life. Palliative treatment was advised to the patient for additional.

Keywords: Apasmara, epilepsy, meditation, Panchakarma, Yoga


How to cite this article:
Sawarkar G, Sawarkar P. Role of Ayurveda in the management of Apasmara: A case study. J Indian Sys Medicine 2019;7:245-8

How to cite this URL:
Sawarkar G, Sawarkar P. Role of Ayurveda in the management of Apasmara: A case study. J Indian Sys Medicine [serial online] 2019 [cited 2020 May 30];7:245-8. Available from: http://www.joinsysmed.com/text.asp?2019/7/4/245/280355


  Introduction Top


Acharya Charaka described Apasmara (epilepsy) as Apagama (loss of) of Smriti (memory) associated with Bibhatsa Chesta (irrelevant behavior) due to derangement of Dhi (thinking capacity) and Sattva (mental strength).[1]Apasmara is described in Madhava Nidana as the loss of Smriti, characterized by Tamaha Pravesha (feeling of aura), which occurs spontaneously.[2] The word “Apasmara” indicates only a clinical sign and not a supernatural cause. Smara means memory. It includes memory, intelligence, and consciousness. Apa means loss. Loss of consciousness is one of the important signs.[3] The clinical features of Apasmara can be correlated with epilepsy in modern medicine. The disease epilepsy is featured about disturbed normal pattern of neural activity, which causes strange sensations, occasional convulsions, muscle spasms, and loss of consciousness.[4] The intention of this case report was to present the constructive approach toward Ayurveda treatment in Apasmara without any unwanted incidences and side effects.


  Patient Information Top


A 52-year-old man was symptomless before 2 years, gradually emerging symptoms likewise mental irritation, disturbed sleep, impairment in Dhi (intellectual), Dhriti (grasping), and Smriti (memory). The patient was unable to recall the events, which was once in 2 months. Then he consulted neurophysician, and he was started on antiepileptic drugs. After regular antiepileptic medication, the patient had no attack of seizure, but he was having a feeling of irritation, depression, lack of interest in surrounding, isolation, and feeling of lethargy.


  Clinical Findings Top


The patient had epileptic convulsions involving recurrent state of unconsciousness, seizures, sweating, memory impairment, and lock jaw during attack, which were bimonthly once. The last convulsive episode was 3 months ago. There was no history of diabetes and hypertension; no significant family history and personal history were observed.

General Examination

Alert with normal sensorium

Vital signs: HR–68/min, RR–18/min, and BP–130/80mm Hg

Central Nervous System Examination

  1. Appearance: Alert, active


  2. Behavior: Cooperative well mannered


  3. Hallucination: No hallucinations during seizure episodes


  4. Intelligence: Normal


  5. Consciousness: Normal


  6. Memory: Normal


  7. Orientation: Normal


  8. Speech: Normal


  • All cranial nerves: Intact


  • Motor system: Not any deformity


  • Sensory system: Not any deformity


  • Cerebellar signs: Nil


  • Signs of meningeal irritation: Nil


Ashtavidhapariksha

  • Nadi: 68/min


  • Mala: Saama, grathit, and irregular


  • Mutra: Samyak


  • Jivha: Saam


  • Shabda: Spashta


  • Sparsh: Anushanashita


  • Druk: Prakrut


  • Aakruti: Krusha



  Diagnostic Assessment Top


Assessment Criteria

For subjective assessment,[5] the following symptoms were kept as parameter [Table 1].
Table 1: MMSE scale for retention of knowledge examination[6]

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  1. Severity of attack
    • a. Grade 0: Myoclonic tremors


    • b. Grade 1: Multi focal clonic tremors


    • c. Grade 2: Generalized tonic tremors


    • d. Grade 3: Frothing + tongue biting


  2. Frequency of convulsion
    • a. Grade 0: No convulsion


    • b. Grade 1: 1 episode/15 days


    • c. Grade 2: 1 episode/7 days


    • d. Grade 3: 1 or more episodes/day


  3. Duration of convulsion attack
    • a. Grade 0: No convulsion


    • b. Grade 1: 5–15 s


    • c. Grade 2: 15–30 s


    • d. Grade 3: >30 s


  4. Ictal features
    • a. Grade 0: No any features


    • b. Grade 1: Headache


    • c. Grade 2: Headache + drowsiness/delirium


    • d. Grade 3: Paresis + other complaints


Therapeutic Intervention

Therapeutic interventions are shown in [Table 2][Table 3][Table 4][Table 5].
Table 2: Phase I: Panchakarma treatment plan

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,
Table 3: Phase II: Palliative treatment plan

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,
Table 4: Plan for pranayama, yoga, and meditation

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,
Table 5: Effect of treatment on symptoms of epilepsy

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Follow-up and Outcomes

Follow-up and outcomes are shown in [Table 5].


  Discussion Top


In this case study, the patient got relief from symptoms of Apasmara with the help of Panchakarma, Shamana (palliative) treatment with Yoga, Pranayama, and Asana. The previously taken antiepileptic drugs medication has many drawbacks such as adverse reaction and drug interaction. Cognitive impairment to an extent is also seen in patients with epilepsy. Panchakarma and internal Ayurveda medicines work surprisingly in this area, and they do a remarkable job. Dhanwantara Taila Abhyanga—cures Kampa (tremors), Akshepa (convulsions), Unmada (insanity), and all types of Vataja Rogas (neurological disorders).[7]Shirodhara makes satiety in head, removes facial wrinkles, Santarpana of Indriya (nourishes all sense organs), and does the Pratipurana of Shiras and acts as Nidra Labha Sukha (gets good sleep easily and feels happy).[8],[9] Body massage with simple or medicated oil increases the blood amino acids such as tryptophan, simultaneously reduces the stress, and stimulates nervous system, ultimately, which acts on muscular system that governed particular nerve actions.[10]

Nasya with Panchagavya Ghrita showed an anticonvulsant effect against maximal electroshock seizure in animal model, which induced seizures and also potentiated the anticonvulsant effect.[11] It also controls the regular occurrence of convulsions and the extent of duration and it does not have any side effect; hence, it can be prescribed for a long time in therapeutic dosage.[12]

Yoga Basti is characterized for curative, preventive, and promotive action. It pacifies the vitiated Vata Dosha in Apasmara and gives results in repetitive attacks. Basti is considered as a wide-ranging key treatment modality for Vata Dosha.[13]

Bramhi Vati, in which Brahmi being a Medhya (brain tonic) drug is recommended for various psychosomatic and psychiatric disorders. It has capacity to cross the blood-brain barrier with the help of cow ghee as a vehicle. Brahmi Ghrita is recommended for the management of Unmada (insanity), Alakshmi (inauspicious), Apasmara (epilepsy), Papavikaras (diseases due to sinful acts),[14] and for Apasmara, Unmada, and Graha Rogas (diseases afflicted by evil spirits).[15]Sarasvatarishta improves general well-being and mental health. It increases immunity, memory, voice quality, feelings of joy, and satisfaction as well.[16]

Mini Mental State Examination (MMSE), the most commonly used measure of the global mental status, is used in the screening for dementia.[17]

Pranayama or deep diaphragmatic breathing exercise reported changes in metabolism, blood flow, and oxygen levels in the blood. The regular practice of pranayama, in which person doing controlled deep diaphragmatic breathing exercise facilitated with reinstate normal respiration; this can reduce the duration of seizure and/or stop the seizure before it becomes full blown.[18]

Asanas or Yogasanas postures aid in reestablishing equilibrium of the body and its metabolic systems. Practicing regular Asanas strengthens person physically and calms the nervous functions. Asanas can be used as a physical exercise alone, which helps to improve circulation, respiration, and concentration, whereas declining the probabilities of seizure.[19]

Dhyana (meditation) is a soothing experience that relaxes the mind and heals the body. Meditation corrects the blood flow to the brain and slows down the production of stress hormones. Simultaneously, meditation increases the levels of neurotransmitters, which keep the nervous system calm. Relaxation techniques, such as yoga and meditation, are well-known effective remedies in seizure control.[20]

The patient got symptomatically result in this scenario, nevertheless evidences such as electroencephalogram and magnetic resonance imaging were not carried out because of financial condition of the patient. So, by conducting clinical trials, one can fix the treatment protocol for Apasmara and facilitate the society with harmless productive treatment.


  Conclusion Top


Panchakarma treatment, such as Shirodhara, Nasya, and Basti along with palliative treatment (Shaman Chikitsa), are safe without any interactions and adverse effects in the treatment in Apasmara. Now, the patient is symptomless and feels relaxed. But he is still on the clinical follow-up. This type of treatment plan can be recommended for large sample size as randomized clinical trial.

Patient Perspective

The patient was satisfied as he had improved, without any side effect, he felt relaxed, and his enthusiasm improved.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Singh RH. Charak Samhita, Chikitsa Sthana 10/3. Delhi, India: Chaukhambha Surbharati Prakashana; 2006. p. 474.  Back to cited text no. 1
    
2.
Upadhyaya Y. Madhav Nidan, Madhukosh Tika, Apasmara Nidana 21/1. Varanasi, India: Sanskrit Sansthana; 2002. p.45.  Back to cited text no. 2
    
3.
Shastri A. Sushruta Samhita, Uttara Tantra 61/3. Varanasi, India: Chaukhamba Sanskrit Sansthana; 2007. p. 81.  Back to cited text no. 3
    
4.
Mishra UK, Kalita J. Clinical Electroencephalography. 1st ed. Vol. 17. Gurgaon, Haryana: Elsevier Publishers; 2009. p. 371-3.  Back to cited text no. 4
    
5.
Nandeshwar KP, Patil PL, Choudhari MC. Ayurvedic management of balapasmara w.s.r. to epilepsy in children along with anti-epileptic drug: A case study. Eur J Pharm Med Res 2017;4:354-7.  Back to cited text no. 5
    
6.
Janowski K, Gustaw K, Kasprowicz M. Application of Choynowski’s memory scale in assessment of patients with dementia. Arch Med Sci 2012;8:130-7.  Back to cited text no. 6
    
7.
Murthy KR. Astanga Hrdayam. Vol. II. 2nd ed. Varanasi, India: Krishnadas Academy; 1995. p. 511.  Back to cited text no. 7
    
8.
Trikamji Y. Sushrutha Samhita, Nidan Stahana. 8th ed. Varanasi, India: Chaukhambha Orientalia; 2005. p. 488.  Back to cited text no. 8
    
9.
Trikamji Y. Charaka Samhita. Reprint ed. Varanasi, India: Chaukhambha Sanskrit Sansthan; 2004. p. 42.  Back to cited text no. 9
    
10.
Roshy JC, Cheian A, Joseph CT. Role of Abhyanga (oil massage) to lead a healthy life. Ayurpharm Int J Ayur Alli Sci 2012;1:163-7.  Back to cited text no. 10
    
11.
Joshi R, Reeta KH, Sharma SK, Tripathi M, Gupta YK. Pharmacodynamic and pharmacokinetic interaction of Panchagavya Ghrita with phenytoin and carbamazepine in maximal electroshock induced seizures in rats. Ayu 2015;36:196-202.  Back to cited text no. 11
[PUBMED]  [Full text]  
12.
Chitrangana CN, Shetty SK, Prakash NB, Raj AGR, Shankar V. Explorative study on efficacy of Ayurvedic therapy and an Ayurvedic compound preparation in the management of epilepsy. Int J Res Ayur Pharm 2014;5:702-7.  Back to cited text no. 12
    
13.
Patil VC. Principles and Practice of Panchakarma. 3rd ed. Atreya Ayurveda Publications; 2012. p. 98.  Back to cited text no. 13
    
14.
Acharya YT. Charaka Samhita, Chikitsa Sthana. Apasmara Chikitsa Chapter 10/25. Varanasi, India: Chaukamba Prakashana: 2009. p. 475.  Back to cited text no. 14
    
15.
Bhavamishra. Bhavaprakasha, Uttarardh 23/18. Varanasi, India: Choukhamba Samskruta Sansthana; 2005. p. 225.  Back to cited text no. 15
    
16.
Saxena S. Saraswatarishta: Uses, benefits, side effects, FAQs and more. Available from: https://cashkaro.com/blog/saraswatarishta-benefits-uses-how-to-consume-side-effects/52063. [Last accessed on 2019 Dec 19].  Back to cited text no. 16
    
17.
Brain Metrix. Available from: http://www.brainmetrix.com/iq-scale/. [Last accessed on 2019 Dec 18].  Back to cited text no. 17
    
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Saxena VS, Nadkarni VV. Nonpharmacological treatment of epilepsy. Ann Indian Acad Neurol 2011;14:148-52.  Back to cited text no. 18
[PUBMED]  [Full text]  
19.
Rajesh B, Jaychandran D, Mohandas G, Radhakrishnan K. A pilot study of yoga meditation protocol for patients with medically refractory epilepsy. J Altern Compliment Med 2006;12:367-71.  Back to cited text no. 19
    
20.
Sahaja Deepak KK, Manchanda SK, Maheshwari MC. Effect of Sahaja yoga practice on seizure control and EEG changes in patients of epilepsy. Indian J Med Res 1996;103:165-72.  Back to cited text no. 20
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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Abstract
Introduction
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