Role of homoeopathy in neurological disorders highlighting importance of 10W’s and plussing method

Classification of neurological disorders

For ease of understanding, neurological disorders can be broadly classified into the following categories based on their pathogenesis:

• Neurodevelopmental: Attention deficit hyperactivity disorder, autism, speech, and language disorders, and Tourette syndrome^[1,2]

• Neurodegenerative: Alzheimer, Parkinson disease, muscular dystrophy/atrophy, and Huntington disease^[1,2]

• Neurometabolic: Wilson diseases, phenylketonuria, homocystinuria, and pyridoxine dependency^[1,2]

• Neurological infections: Encephalitis, meningitis, brain abscess, cysticercosis^[1,2]

• Neoplasms: Glioma, astrocytoma, ependymoma, oligodendroglioma, and gliosarcoma^[1,2]

• Cerebrovascular: Stroke, carotid stenosis, aneurysms and vascular malformations.^[1,2]

Secondary neurological signs and symptoms can occur due to disorders of other body systems, such as head injuries and Vitamin B12 deficiency.

In this article, we will be discussing homoeopathic management of neurological conditions arising as a complication of neurological infections with the help of a case example.

Importance of 10 W’s – An extension of Boenninghausen’s 7 W’s

Let us understand how having the case in the 10W’s format helps in better understanding

Who? Quis

The homoeopath must know WHO they are treating if they wish to understand the cause of the derangement of the health of the patient. The personality and individuality of the patient must stand at the head of the image of the disease. The bodily constitution, miasmatic spectrum, temperament, interest, and hobbies are the factors that define the WHO for us.

What? Quid

It is essential to know the kind of disease and the stage of disease we are treating, so we need to know the nature and peculiarity of the disease.

Where? Ubi

It is important to the seat of the disease. Where are the symptoms located? On what level are the characteristic signs and symptoms found, physical, vital, or mental plane?

With What? Quibis Auximis

The concomitant symptoms appear in the patient synchronistical to the main complaint. The concomitant is the totality of what aggravation and amelioration are to individual symptoms. They help us form a complete picture of the disease.

Why? Qur

The cause of the disease is very important to study because it helps in choosing a proper homoeopathic remedy, managing the case, and removing the obstacles to cure. Homoeopathy sees cause and effect as two sides of the same phenomenon. Cause and effect are functional polarities that appear and disappear together.

What effects? Quomodo

This relates to the modalities that make something better or worse. It includes factors such as air, pressure, motion, eating, and drinking.

When? Quando

This section studies the chronological development of the disease and the complete case history. Knowing this helps us to trace Hering’s law of direction of cure.

Watch out for!

This includes the subjective signs and symptoms: The gestures, body language, energy and doodles.

Which kingdom?

Classification of the patient in the process of case taking helps us to narrow down the search of the similitude to a group of remedies. Broader classification according to prime features of the kingdoms, like structure for minerals, survival for animals, sensitivity for plants, desperation for nosodes, exaggerated organ association for sarcodes, and infinite and immaterial themes for imponderabilia.

Once the kingdom is classified further narrowing down to the rows and columns (mineral kingdom) or subkingdom of animals and plants helps us to reach the similimum with accuracy.

What intensity?

The maism has to be settled on before searching for the remedy. The drug must match the pace, nature and pathology of the disease.

Patient information

The patient is a 37-year-old Muslim male working in a call centre who recently had meningitis and now has right ptosis.

1) Who?

Lives with his parents, wife and two daughters. Has completed B.Com and works at a call centre in the night shift.

Childhood: Used to play indoor games. Was not allowed to go out and play. Frequent tonsillitis especially during examinations. Was the eldest child, so was pampered by the grandparents. Was average in studies. Did not enjoy studies. Loved reading horror novels.

Anger: When contradicted. Shouts if angry. Anger and irritation at trifles.

Loves being around people. Extrovert. Mixes with people easily. Enjoys his work. Says that the night shift does not bother him.

Fear of being alone.

Fear of cats, cockroaches, and high places.

Feels active more at night even during childhood days.

Good confidence and leadership skills. Has 12 people working under him. He is the tech leader.

Love for horror movies and stories.

Anxiety – time set.

Does not share his problems or emotions with anyone.

Restlessness ++ constant needs to change place.

Gets irritated when someone keeps asking him things to do in a certain way.

2) What?

Started with toothache, fever, and headache. Went to the dentist and took medication, which relieved fever and headache. Had dental caries, due to which tooth extraction was done on November 05, 2019. After the extraction, the fever increased and started developing ptosis of the right eyelid along with restlessness and loss of control over urine. His blood pressure shot up to around 250 mmHg systolic. He was hospitalised and investigated, after which a diagnosis of tubercular meningitis with diabetes mellitus and hypertension. He was started on anti-Koch’s therapy.

Now

• Loss of control over urination for 1 month

  Currently catheterized

  Urine – Orange.

• Ptosis of the right eyelid for 1 month

  Diplopia in the right eye upwards and downwards

  Loss of power of eye muscles

  Cannot walk properly, Loss of balance and needs

  support to walk.

• Vertigo for a month

  <Staring at a point for 30–40 s

• Lower back pain for 3 weeks

  <Lying on back for too long

  <Sitting >Pressure

  >Hot fomentation

3) Where?

• Nervous system

• Musculoskeletal system

4) When?

• Nervous system

  • Loss of control over urine for 1 month

  • Ptosis for 1 month

  • Vertigo for 1 month

• Musculoskeletal system

• Lower back pain for 3 weeks

5) With what?

Appetite – Decreased, wanting appetite, feels food is tasteless

Thirst – 5–6 glasses/day

Craving – Fish+++/Chicken++, salty food

Aversion – Bitter things/bitter gourd

Perspiration – Face/back

Stool – Irregular bowel movements

Urine – Orange (due to medicines?)

Sleep – Disturbed, due to back pain, sleeps on the right side, snoring

Dreams – Does not remember

6) What effects?

Vertigo < sitting < staring at one point

Backache < sitting

<Lying on back for too long

>Pressure

>Hot fomentation

7) Why?

A/F – tubercular meningitis

Tooth extraction?

Medical history

Meningitis at 37 years of age

Car accident – right hand fracture – at 32 years of age

Measles – 6 and 10 years of age

Mumps – 5 years of age

Whooping cough? – 4 years of age

Chickenpox – 3 years of age

Family History

Father – Diabetes mellitus

Mother – Hypertension/Rheumatism/Hyper-cholesterolaemia/Diabetes mellitus

Grandfather (P) – Anaemia/Tuberculosis/Asthma

Grandmother (P) – Diabetes mellitus/Hypertension/Chronic kidney disease

Grandfather (M) – Arthritis

Grandmother (M) – Diabetes mellitus/Hypertension/Chronic kidney disease

8) Watch out!

9) Which kingdom? (Discussed later)

10) Which remedy? (Discussed later)

Clinical findings

Pulse – 88/min

BP – 140/90 mmHg

Weight – 74.5 kg

RS – AEBE, Clear

CVS – No abnormalities detected

Eye Examination

Right eye – Ptosis

Vision – Central and peripheral visual fields normal

No other visible deformities or opacities.

Totality – Boenninghausen’s method

QUIS – Personality (Mental Generals)^[6]

• Anger from contradiction, at trifles

• Fear of being alone

• Fear of high places

• Anxiety

• Restlessness

QUID – The disease^[6]

• Ptosis of right upper eyelid

• Involuntary urination

• Backache

UBI – Seat of disease^[6]

• Eyes – Eyelids

• Central Nervous System – Meningitis/vertigo

• Bladder

• Back

QUIBIS AUXALIS – Accompanying symptoms^[6]

• Vertigo – staring or looking at point continuously

• Urine – orange

• Desires chicken

• Desires fish

• Desires salty food

CUR – Cause of disease^[6]

• Meningitis

• Tooth extraction

QUOMODO – Aggravation and Amelioration^[6]

• <Sitting

• <Staring at one point

• <Lying on back for too long

  • Pressure

  • Hot fomentation

QUANDO – Time

Rubrics – Boger Boenninghausen’s Characteristics and Repertory (BBCR) [Figure 1]

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Figure 1:

Repertory sheet 1 – All remedies.^[12]

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Mind – Anger, crossness:

Mind – Anxiety, agony:

Mind – Fearsome, anxiety, dread, frightened easily: Alone, of being:

Mind – Restlessness:

Eyes – Eyelids: Paralysis, drooping, ptosis:

Upper:

Urine – Micturition: Urination:

Involuntary:

Back – Lumbar region: Pain:

Vertigo – Vertigo:

Appetite – Desire for: Salty things:

Appetite – Desire for Fish:

Head – Internal: Inflammation: Meningitis:

Aggravation and Amelioration – Sitting: Agg.:

Aggravation and Amelioration – Lying: On back: Agg.:

Aggravation and Amelioration – Pressure: External: Amel.:

Aggravation and Amelioration – Cold: In general, agg.:

Aggravation and Amelioration – Looking: Intently, fixedly, straining the vision, agg:

Analysis and synthesis

Let us go back to Questions 9 and 10

Which Kingdom?

From history, it is evident that he is a workaholic, achiever, and performer. Therefore, the themes of responsibility, leadership, role, and performance are marked, which point to the mineral kingdom. This can be differentiated from the animal kingdom where there will be more energy put into survival, which will be seen as competitiveness, attack, and defence at the workplace, all of which are not present in this case.

What Intensity?

A very reliable indicator of the intensity and pace of disease is the dominant miasm. The dominant features of this particular case are post-tubercular sequelae, rapid progress into deeper pathology, and infection leading to nerve damage causing ptosis. Moreover, from history, the features of restlessness with a constant desire to change and the desires for chicken and fish are strong indicators of tubercular miasm.

Differentiation and selection of remedy

Now with these two answers – Mineral kingdom and Tubercular miasm, we now look at the repertorial analysis after applying the Mineral and Tubercular remedy filter and narrowing down on the mineral kingdom remedies. [Figure 2]

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Figure 2:

Repertory sheet 2 – Mineral kingdom remedies (mineral kingdom and tubercular remedies filter applied).^[12]

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The top mineral kingdom remedies are –

Phosphorus (Row 3 Column 15)

Sulphur (Row 3 Column 16)

Causticum (Potassium) (Row 4 Column 1)

Arsenic alb (Row 4 Column 15)

Calcarea carb (Row 4 Column 2)

Silicea (Row 3 Column 12)

Natrum mur (Row 3 Column 1)

Nitric acid (Nitrogen) (Row 2 Column 15)

Zincum (Row 4 Column 12)

Going in details of the features of these Rows,^[7] we see that Row 4 corresponds most to the case. Therefore, now we narrow down to Causticum, Calcarea carb, Arsenic alb and Zincum. The column analysis shows that the features of column 12 are in correspondence with the case.

Features of Row 4^[7]

Themes of Security and Task. Security is often searched for in terms of money, relationship, job, and health. ‘There is an attack and he has to defend himself.’

The keywords of Row 4 are – Security, Protection, Attack, Safety, Defence, Job, and Task.

Features of Column 12^[7]

There is constant attack to the structure and there is constant fight to prevent damage. Constant vigilance, alertness, and restlessness.

The Keywords of Column 12 are – Threat, Attack, Alert, Struggle, and Unsuccessful efforts.

From the Materia Medica reference, the supporting points in favour of Zincum over Causticum, Calcarea, and Arsenic alb are

Kent’s Materia Medica – Zincum metallicum^[8]

‘….after badly treated meningitis; tubercular meningitis.’

Boericke’s Materia Medica – Zincum metallicum^[9]

Eyes: ‘……Pressure as if pressed into the head. Itching and soreness of lids and inner angles. Ptosis. Rolling of eyes….’

Final remedy

Zincum met.

Posology

Zincum met 200 in plussing mode every 15 min for 7 days.

What is the plussing method and why was it used in this case?

The plussing method is a method of dose administration advocated by Dr. Ramakrishnan, which involves diluting a medicine in water, taking a spoonful of it at regular intervals and stirring it before every dose. This is done to increase the potency of the medicine slightly from its previous dose.^[10]

Why plussing? Because it minimises the risk of aggravation and improves the power of the medicinal substance.

Why were LM potencies used?

Initially, the case was started with the CH potency in the plussing method; however, with the CH potency, the risk of aggravation is more when the dose is repeated frequently. This risk is minimised substantially when LM potencies are used. As Dr. Hahnemann writes in the 6^th edition of Organon Aphorism 246–247, the medicinal aggravation encountered due to repetition of the medicine can be avoided by the use of his altered and perfected method which he later talks about in detail in Aphorism 270. Thus, he advised giving medicines diluted in water, which can be repeated daily in chronic cases and as frequently as every 10 min in acute cases.

LM6 was selected keeping in mind the rapidity in which the pathology was advancing. Moreover, the patient had strong vitality to withstand a higher LM potency.

Final prescription

December 16, 2019 – Zincum met 200 in plussing mode every 15 min for 7 days

Follow-up and Outcome

Physiological importance of zinc

Zinc is a trace mineral and is necessary for most enzymes to carry out their enzymatic actions. It plays an important role in DNA synthesis, cell growth, protein synthesis, healing damaged tissue and supporting a healthy immune system.^[11]

The recommended dietary allowance for adults 19+ years is 11 mg a day for men and 8 mg for women. Pregnancy and lactation require slightly more at 11 mg and 12 mg, respectively.^[11]