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| CASE REPORTS |
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| Year : 2019 | Volume
: 7
| Issue : 4 | Page : 245-248 |
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Role of Ayurveda in the management of Apasmara: A case study
Gaurav Sawarkar1, Punam Sawarkar2
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 Submission | 20-Dec-2019 |
| Date of Decision | 22-Jan-2020 |
| Date of Acceptance | 11-Feb-2020 |
| Date of Web Publication | 14-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
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/JISM.JISM_63_19
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 |
| Introduction | |  |
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 | | |
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 | | |
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
- Appearance: Alert, active
- Behavior: Cooperative well mannered
- Hallucination: No hallucinations during seizure episodes
- Intelligence: Normal
- Consciousness: Normal
- Memory: Normal
- Orientation: Normal
- 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 | | |
Assessment Criteria
For subjective assessment,[5] the following symptoms were kept as parameter [Table 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
- 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
- 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
- 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]., , ,
Follow-up and Outcomes
Follow-up and outcomes are shown in [Table 5].
| Discussion | | |
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 | | |
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 | | |
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
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