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Case Series
6 (
3
); 123-132
doi:
10.25259/JISH_62_2022

Understanding the scope of Homoeopathy along with a multidisciplinary integrated approach for holistic management of epilepsy with co-morbidity in children: Case studies

Department of Practice of Medicine, Smt. Malini Kishore Sanghvi Homoeopathic Medical College and Hospital, Vadodara, Gujarat, India
Department of Repertory, Smt. Malini Kishore Sanghvi Homoeopathic Medical College and Hospital, Vadodara, Gujarat, India
Corresponding author: Dr. Mrunalika Dhaval Dikshit, Department of Practice of Medicine, Smt. Malini Kishore Sanghvi Homoeopathic Medical College and Hospital, Karjan, Vadodara, Gujarat, India. dr.dikshit16@gmail.com
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Dikshit MD, Parikh HM. Understanding the scope of Homoeopathy along with a multidisciplinary integrated approach for holistic management of epilepsy with co-morbidity in children: Case studies. J Intgr Stand Homoeopathy 2023;6:123-32. doi: 10.25259/JISH_62_2022

Abstract

Epilepsy is a complex neurological disorder that affects the patient’s mental and physical development as well as their functioning, especially in children. It also presents with mental and/or physical co-morbidities/disabilities. This manuscript describes the importance of an individualised multidisciplinary integrated approach, including homoeopathy, for the holistic management of epileptic children through two illustrative cases. The team included homoeopaths, paediatricians, paediatric neurologists, physiotherapists, and psychologists in both cases. We aimed to demonstrate the scope of the homoeopathic individualised approach for managing epilepsy and its role in improving the quality of life of patients and caretakers. Both cases involved detailed case-taking, including homoeopathic and clinical perspectives. A multidisciplinary integrated approach enabled a comprehensive clinical diagnosis. An individualised approach was used to form a totality and perform repertorisation to select the most appropriate remedy and potency. Follow-up criteria enabled us to measure the progress. The homoeopathic individualised approach resulted in considerable relief in seizures and a reduction in allopathic medication available only in 1st case. and relief in seizures in both the cases. The functioning of the patient and their quality of life improved considerably in both cases as well. Homoeopathic individualised approach, along with the integrated system, helps in the relief/cure of epileptic episodes, enables a reduction in the use of antiepileptic drugs, and improves associated co-morbidities. Through this approach, holistic care is possible and improves the quality of life of the child and the parents.

Keywords

Epilepsy
Homoeopathy
Individualise holistic approach
Integrated approach

INTRODUCTION

An epileptic seizure is a paroxysmal disorder characterised by abnormal, excessive, and hypersynchronous discharges of neurons leading to alteration of function. Epilepsy is not a disorder but a symptom of underlying brain dysfunction.[1] It is a condition characterised by repeated unprovoked seizures. If seizures are consistently provoked, such as by fever or hypoglycaemia, the term epilepsy should not be used.

The International League against Epilepsy provided a new definition in 2014. Epilepsy is a disease of the brain defined by any of the following conditions:

  1. At least two unprovoked (or reflex) seizures occurring more than 24 hours apart.

  2. One unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures occurring over the next ten years.

  3. Diagnosis of epilepsy syndrome.

Epilepsy is considered to be resolved for individuals who had age-dependent epilepsy syndrome but are now past the applicable age or those who have remained seizure-free for the past ten years, with no seizure medicine administered in the past five years.[2]

Classification of the epilepsies

The new multilevel classification of epilepsies is designed to classify epilepsy in different clinical environments [Figure 1]. Where possible, a diagnosis at all three levels should be sought, as well as the aetiology of the individual’s epilepsy.[3]

Figure 1:
Framework for classification of the epilepsies. Denote onset of seizure.[3]

Classification serves many purposes

  • Provides a framework for understanding the predominant type of seizures in the patient and the other types likely to occur.

  • Provides potential triggers and prognosis for seizures.

  • Informs the risks of co-morbidities including learning difficulties, intellectual disability (I.D.), psychiatric features such as autism spectrum disorder, and mortality risk such as sudden unexpected death in epilepsy.

  • Classification often guides the selection of antiepileptic therapies.[3]

The team of the Institute of Neurology and Neurosurgery focused on the understanding of symptomatic generalised epilepsy. Symptomatic epilepsy is defined as epilepsy after an injury to the brain that is known to be capable of causing epilepsy. Examples are as follows: significant head injury, central nervous system (C.N.S.) infection, stroke, brain tumour, and surgery. There is commonly more than one seizure type in symptomatic generalised epilepsy. The seizures are commonly resistant to medication, and often multiple medications are required. These epilepsies have a higher comorbid I.D., cerebral palsy, or other developmental problems.[4]

Neonatal seizures

Neonatal seizures are fairly common. They are defined as the occurrence of sudden, paroxysmal, and abnormal alteration of electrographic activity at any point from birth to the end of the neonatal period. When a patient with neonatal seizures is encountered, it may be the first clinical sign of a serious neurologic disorder. Thus, rapid recognition and evaluation are required to identify and treat the underlying aetiology, prevent further brain injury and extinguish the seizure activity. At birth, the brain is in a state of continued development; some areas are immature. If the neonatal brain is pathologically provoked, it may cause seizures. Due to its immature state, the neonatal brain is prone to seizures due to an imbalance between neuronal excitation and inhibition. The factors causing this imbalance include metabolic disturbances, hypoxic conditions, an inborn error of metabolism, intracranial haemorrhage, C.N.S. infection, thromboembolic, neonatal epilepsy syndrome and congenital brain malformation. The prognosis of neonatal seizures depends on the underlying aetiology. If the electroencephalogram (E.E.G.) is normal, the prognosis is excellent; conversely, an abnormal E.E.G. may indicate a poor prognosis and the development of conditions such as cerebral palsy and epilepsy. The presence of spikes in E.E.G. indicates a 30% risk of developing future epilepsy. The mortality rate of neonatal seizures is reported to be as high as 20%. In survivors, neurologic impairment, disability, developmental delay, and epilepsy are common. Both the cases studied in this paper demanded a complete understanding of the evolution of neonatal seizures at the time of neonatal age.[5]

Epilepsy with co-morbidities

Many epilepsies are associated with co-morbidities such as learning, psychological and behavioural problems, or psychosocial concerns ([Figure 1], left vertical oval). In the more severe epilepsies, a complex range of co-morbidities may be seen, including motor deficits such as cerebral palsy or movement disorders. The presence of co-morbidities is considered for every patient with epilepsy at each stage of classification, enabling early identification, diagnosis, and appropriate management.[3]

Epilepsy and homoeopathy

According to Dr. Hahnemann›s disease classification, epilepsy is a chronic miasmatic periodic disease. There are more than 500 remedies in homoeopathy for seizures with a specific indication for episode/type of seizures. As epilepsy is a chronic disease, it requires a constitutional or deep-acting remedy. Not all the above-mentioned remedies can be classified as constitutional. However, a specific remedy may help control an acute seizure.

Several papers are available that provide a focused, detailed clinical perspective as well as a deep understanding of homoeopathic disease classification and therapeutic approach. All have concluded that homoeopathy helps in the management of epilepsy through an individualised approach.[6-10] However, all these papers are based on materia medica and therapeutics; none have examples of cases.

Therefore, we present two case studies focusing on the outcome of cases of epilepsy in children through a homoeopathic individualised integrated approach.

CASE SERIES

Case 1

Baby C.V.S (case No 9165), 3.5 years (D.O.B – 28/8/2013), was brought by parents on 20.1.2017. The parents reported seizures, delayed speech, and non-cooperative behaviour.

Chief complaints

She is suffering from epilepsy, poor fine motor function , non- cooperative and non communicative behaviour and yet speech is not developed [Table 1].

Table 1: Chief complaints
S. No. Location Sensation Modality Accompaniment
1. C.N.S. Birth/H: Breech presentation, full term, LSCS, cried immediately after birth, Weight: 2 kg.
Onset: 3rd day of life H/O refused to suck/eat A/F-hypoglycaemia
D: 13 days H/O seizures, Rx.-Inj. cefixime
Diagnosed with hypoglycaemic seizures Inj. genta
Tonic posturing (from documents) Inj. Ca Gluconate, 25 cc+D25%
RBS-32 Inj. Phenobarbital
Hospitalisation Inj. Phenytoin
After discharge/ Ictal symptoms: Frothing from the mouth, up > AEDs (details not available)
frequency-7-8 times/day rolling of eyeballs, sudden
duration-2-3 min. blankness
At 6 months of age Headholding not developed >Physiotherapy
(1) From 2013 till today Ictal symptoms: - GTCSs valparin 5 mL/BD (2015)
Mouth frothing <ANGER3
Eyes up and rolling
F-Once/7-15 days Loss of awareness
D-1-2 min
(2) From 2015 till today Stretching 3
Fingers both hands No loss of awareness
F: 8-9 times/day D: 1 min.
At 3.5 years of age Gross motor functions developed in a timely manner.
Fine motor skills not developed (eating, writing)
> After physiotherapy - 3
Mind Non-cooperative Poor eye contact - 2 Understanding poor - 2 SOCIALISATION poor - 2

AED: Antiepileptic drug

Associated complaints [Table 2]

Mo. Obstetric/H: G3P2A1, G1: Male 12 years old (Normal), G2: Natural abortion, G3: Patient MO. Antenatal/H: PIH, (AHT Rx).

Table 2: Associated complaints
S. No. Location Sensation Modality Accompaniment
1. R.S. Nasal discharges - 2 A/F Change of weather
Since birth Sneezing - 2 > Allopathic Rx
F-related to modality Fever - 2
D: 4-5 days
2. General HT-87.5 CM, Wt.-10.3 kg, H.C-43 cm
Diet eats in excessive quantity3

Marital history of parents: non-consanguineous.

Stool: Hard 3. Since last month, 3–4 times/day. Semisolid, yellowish, no abdominal pain.

Craving: Sweets 3.

Examination

H.T.: 87.5 cm WT.: 10.3 kg H . C : 4 3 c m

P/A: SOFT RS/CVS/CNS: N.A.D.

Investigation

9/5/2015, BERA: Normal hearing

8/8/2015: E.E.G. Bioccipital, interictal epileptic form discharges suggestive of focal epilepsy

Magnetic resonance imaging (M.R.I.): Not available

30/11/16: Ophthalmic opinion: Bil eye -> Visual error reflex (near vision). Advised glasses, but the patient refused.

Diagnosis

Focal epilepsy + G.D.D. + recurrent simple rhinitis + speech not developed + visual error reflex + malnutrition (grade II) + moderate I.D. with mild autism (psychologist assessment advised).

Patient as a person

Her father is a health worker at P.H.C. The parents’ nature is fairly calm, but the mother is anxious about her daughter’s complaints and behaviour. She is obstinate – 3, demanding – 3, moody – 3, and aversion to touch – 3. She is irritable – 3 –cranky – 3, throws things – 3 and beats – 3 and leads convulsions 3. She cries – 2 and shouts – 2 without any reason. She obstinately – 3 demands things but rejects them when they are offered. If anyone tries to console her, she becomes crankier. She likes dancing – 2 and has a fear of being alone – 2.

Approach

Kent: Characteristics, qualified mental symptoms, and characteristic physical general and particular symptoms.

Totality

Repertorial syndrome [Figure 2]

  1. Consolation < anger – 2

  2. Shouting without reason – 2

  3. Cry without reason – 2

  4. Beating others without reason – 2

  5. Fear of being alone – 2

  6. Like dancing – 2

  7. Obstinacy – 3

  8. Cranky – 3

  9. Moody – 3

  10. Wants more food

  11. C.R. Sweet – 3

  12. Hard stool – 3

  13. Coryza – from change of weather

  14. Sneezing – from change of weather

Figure 2:
Case 1-Reptorisation sheet.

Thermal differential field

Chilly remedies: Sepia,Cina, Calc.Carb, Silicea, Igantia, Phos, Tarentula.

Hot-Chilly remedies: Lyco., Nat.Mur, Carcinosin

Hot remedies: Tuberculinum, Sulphur

Potential differential field [Table 3]

  • ➜ Closely coming remedies: Cina, calc carb, and tarentula.

  • ➜ Considering touchiness, crankiness, convulsion modality, and thermal state, cina was selected.

Table 3: Potential differential field
Name of remedy Sepia Cina Calc carb Silicea Ignatia Phosphorus Tarentula
Anger -*→ Convulsion - 1 3 - - - -
<Touch 3 - 2 1 2 - - 3
Striking from anger 3 - - - - - - -
Reject the things when offered 3 - 2 - - - - -
5/3 4/2 2/1 3/1

Susceptibility: Moderate

Sensitivity: Moderate to high

Dominant miasm (DM): Tubercular

Reason: Sudden onset, fast progress, structural, irreversible, and static pathology in the brain with excessive electrical brain discharge. Post hypoglycaemic seizures ➜ Possibility of neonatal hypoglycaemic brain injury.

Treatment: Cina 200 1P/Weekly (W)

Advice: Physiotherapy and psychologist consultation, continue antiepileptic drug (AED), E.E.G., and M.R.I.

Follow-up criteria

Follow ups-[Table 4],

Table 4: Follow ups
Date/Duration 1 2 3 4 5 6 7 8 9 10
20/1/2017 to 14/4/2017 (4 months)
A > o > > > > > S S Bisyllabic >
B > o 30/3/2017. S.Q S.Q >/once/
month
96 40 4/4/2017
Normal
1/month --
Stool c/o: Within one month-0, Seizures-once/week: Stretching in fingers.
14/4/2017-Ht.-87.5 cm, Wt.-10.6 kg, HC-43.5 cm
Last episode 30/3/2017: single episode, 15 min: Generalised seizure.
Follow command: Daily activity, bring water, Food intake: quantity reduced.
21/2/2017: Psychologist’s opinion, moderate I.D. (IQ-40) with mild autism (Autism score/AS-96) (play and behaviour therapy and modification, speech therapy, home-based management-report attached).
R.S.- >3 with puls 200 TDS/3 days.
Till 14/4/2017: CINA 200 1P/Weekly (W), On 14/4/2017: CINA 200 1P/W+TUB 1M 1P Intervention of I.R.: Seizure episode → Intervention with Tuberculinum
12/5/2017 to 22/3/2019 (2 years and 2 months)
A >2 >2 >2 >2 >2 All Achieved
(A)
A small sentences >2
B >2 30/3/2017 > ½-0>3 >3 Dec. 18 →94 Dec. 18→48 -- Once/month
22/3/2019-Ht.-110 cm, Wt.-13 kg, HC-44 cm
Seizures: only while angry, stretching in fingers intensity>2.
AED: May 17 OD, From August 18: stopped as advised by the paediatrician.
Cognitive development: normal schooling started, no complaints from school.
R.S.: 4 Episode>3 with A.R.
• Cina 200 1P/HS/W ^ 3P/
March 19: Cina 1M 3P/W
21/5/2019 to 25/12/2020 (3 years)
A 0 0 >3 N >3 N A 2/lost
control
N N
B 0 0 0 0 2>3 itself -- -- -- No session +
10/7/2020-Ht.-113 cm, Wt.-15 kg, HC-45 cm
From 1/12/2020-Trembling in hand2-occasionally (not other history/symptoms available).
Psychological assessments were not done. As the family had moved elsewhere, the medicine was sent via courier. Parents: Happy and satisfied with the child’s progress.
• Cina 1M/3P/W
• Tuberculinum 1M 1P/One dose
27/4/21 to 26/11/22 (5 years)
A 0 0 0 N N N A A N N
B 0 0 0 0 0 0 55 50 Stopped >3
26/11/22 - Ht.-126 cm, Wt.-20 kg, HC- 45 cm
Trembling in hand-0 (within one month), attends school without problems, identifies all things, difficulty in writing.
Psychologist’s opinion: 26/11/22, I.Q. 50, moderate I.D., AS: 55 (<70: Indicates no autism) (report attached) → Parents want to continue treatment for better scholastic performance.
• Cina 1M/3P/W

AED: Antiepileptic drug, IQ: Intelligence quotient, OD: Once daily

Follow-up evaluation

  • ➔ Child becomes calm and achieves bladder and bowel control.

  • ➔ Acute episode of respiratory infection initially handled with acute remedy and later with deep-acting remedy.

  • ➔ Behavioural improvement continued despite fewer psychotherapy sessions.

  • ➔ Normal schooling started, indicating improvement in cognitive function.

  • ➔ Similimum helps to stabilise susceptibility, leading to stoppage of seizures and reduction in AEDs.

  • ➔ Moderate ID (40) with mild autism (AS-96): End of 5 years IQ-48 and AS is 55, indicating moderate I.D. with no autism.

  • ➔ Tuberculinum helped to stop the episodes of seizures, and R.S. c/o.

Learning

  • Detailed birth history and evolution of disease help to derive the current clinical state.

  • Qualified mental symptoms and observation help in the selection of similimum.

  • Moderate susceptibility with high sensitivity requires moderate potency.

  • Tuberculinum as an intercurrent definitely helps to stabilise the susceptibility and hasten the process of recovery.

  • Withdrawal of AEDs in such cases is challenging; however, with the integrated approach and regular intervention of homoeopathy, it is possible.

  • Changes in E.E.G. findings, improvement in the I.Q., and achieving bladder and bowel control are proof of the process of recovery. The individualised remedy, along with the interdisciplinary approach, plays a role in holistic improvement.

Case 2

Parents brought their 11-year-old son (D.O.B- 30/9/2008) (case no. 12039) in a bedridden state on 15.11.2019 with frequent episodes of seizure since birth. They had tried several AEDs and followed the keto diet without a satisfactory outcome. Parents are frustrated from frequently changing epileptic drugs and doses.

Current clinical state [Table 5]

Table 5: Current clinical state
S. No. Location Sensation Modality Accompaniment
1. C.N.S.
Birth
Birth/H: FTND, BCIAB, Weight-2.8 kg
O: 3rd day of life Generalised clonic seizures, Up rolling eyeballs, A/F- hypoglycaemia>+AEDs
F-7-8 times/day D-15-20 min frothing
F-20-25 time/day 7-8 jerks at a time Quick, generalised, involuntary jerks
5th day Hypoglycaemic seizure with Jaundice
At present Pre-ictal: Shrieking3 (Since last year) Syp.
F-0-4 time/day, D-5-15 Ictal symptoms: -generalised clonic seizures, Divalproex 300 mg/BD,
Min. Up rolling Tab. lamotrigine 25 DT/BD,
Eye frothing Tab perampanel 2 mg/2 tab/
Mouth OD, Syp. Levo-carnitine 5 mL/OD
F-15-20 time/day 7-8 at a time Same
General development Head holding, sitting, standing, speech not achieved Generalised spasticity3, Drooling3 Hearing normal
Social development not achieved
Not>even with physiotherapy
Mind No understanding about family members, strangers, place, things.
Psychologist’s opinion: profound I.D. (IQ-5)

AED: Antiepileptic drug

MO. Obstetric/H: G2P2A0, G1: Patient, G2: 2 ½ years male: Normal

Mother antenatal/H: NIL

Parents’ marital history: Non consanguineous

Family/History: paternal grandparents: Hypertension, paternal uncle: died four years prior due to oral cancer

O/E: Wt: -21 kg HT-125 cm P-94/min, R S /

CVS/P/A-NAD

C.N.S.: Tone: Hypertonia +3 in all Limbs Power: Bil. UL/LL+

Diagnosis: quadriplegic spastic cerebral palsy + symptomatic generalised epilepsy + profound I.D.

Investigation [Table 6]

Table 6: Investigations, Case 2
9/2/10 E.E.G. Abnormal sleep E.E.G. showing generalisation and multifocal Bilateral Mainly post-epileptic form abnormally with dysfunction
16/2/10 M.R.I. The bilateral frontal periventricular white matter with associated volume
loss suggestive gliosis sequel of hypoxic-ischaemic brain damage. Corpus callosum and subcortical cerebral atrophy
17/1/14 E.E.G. Epileptic form activity of myoclonic in nature from the left occipital hemisphere with secondary generalisation with diffuse slowing from the left anterior hemisphere.

E.E.G.: Electroencephalogram, M.R.I.: Magnetic resonance imaging

Patient as a person

Parents are educated and oriented. They brought him with the hope of reducing the frequency of seizures. They are aware of the prognosis of the disease condition.

He looks fair, lean, and thin, remains in his own world, prefers to play alone, and becomes angry when any guest comes home or brings him outside. He is fastidious – 2, has an aversion to touch – 3, and startles – 3 from noise.

Observation: Continuous nodding of head - 3

Non-repertorial approach: Eliminating symptoms:

Selection of remedy: Nat mur

Susceptibility: Low

Sensitivity: Moderate

Fundamental miasm: Psora + Syphilis

D.M.: Tubercular ➜ Syphilis

Reason: Sudden onset, fast progress, Structural, irreversible, static hypoxic ischaemic pathology leads to atrophy of brain structure and brain malformation with excessive electrical brain discharge.

Treatment started: Nat mur 0/1 3P/W

Advice: Admission for physiotherapy and psychotherapy, continue AEDs

Follow-up criteria:

Follow up Details: [Table 7]

Table 7: Follow up [Case 2]
Date/Duration 1 2 3 4 5 6 7 8 9 10
Nov. 19 to July 20
(9 months)
A > S > 5 min > >/7–8/day (4–5) >2 S S S
B S S S S S S Admitted/weekly/month S -- --
Started responding to sounds of a known person/physician
• Nat mur 0/1 3P/W ➜ N. M 0/2 daily HS
July 20 to Nov 21
(2 years)
A >2 >2 Once/15 days >2 5 min s >2/3–4/day (2–3) >2 babbling >2 >
B > S > > > > same SQ -- --
Started head holding, O/E: Tone: > + Hypertonia, Power: SQ
• Tuberculinum 0/4 1P H.S. alternate week to W
• Nat mur 0/2 HS daily ➜ B.D.
Nov 21 to July 22
(2 years and 8 months)
A >2 >2 once/2–3 month >2 5 s 0 >3,3-4/day, (1–2) >3 monosyllabic >2 >2
B > > > > > > 1/month S.Q. Done > 7
Aware of his name
E.E.G.: Nov 21 Abnormal, slow spike and wave complex, s/o: Symptomatic generalised epilepsy
Major supported: sitting 10 min., standing 5 min.
• Tuberculinum 0/4 1P HS/W
• Nat mur 0/2 BD daily

E.E.G.: Electroencephalogram

Follow-up evaluation

  • ➔ Considering pathology and multiple types of seizures, susceptibility and sensitivity demanded a frequent repetition of deep-acting remedies and frequent anti-miasmatic remedies in 50 millesimal potencies.

  • ➔ After two years, the child started sitting and standing with support. The state and stage of pathology demanded daily rehabilitation, but after a few months, only one therapy session per month was possible. Due to this, there was limited improvement developed in gross motor, fine motor, and cognitive function.

  • ➔ Deep-acting remedy with an intercurrent remedy in frequent repetition helps to control seizures without modification of AEDs, which had previously been frequently modified.

  • ➔ With the help of similimum, susceptibility stabilised002C and a gradual reduction in seizure episodes occurred, with improvement in the patient’s physical capacity.

Learning

  • Multiple types of seizure presentations require skill to understand the clinical state, all of which help in case taking.

  • The concept of eliminating symptoms and observation helped in the selection of similimum.

  • Low susceptibility with moderate sensitivity required 50 millesimal potency with frequent repetition.

  • The case demanded regular stimulation of susceptibility with intercurrent remedy It hastened the process of recovery.

DISCUSSION

Both cases have different types of seizures, pathology, and associated psychological and neurological co-morbidities, which demand skills for case taking, recording, and understanding of clinical stage, prognosis, and management strategy even with limited data/investigation of previous history in rural set-up. Both cases focus on the importance of the repertorial and non-repertorial approaches, eliminating symptoms/observation for the selection of deep-acting individualised remedies with the demand of an integrated approach. Case 1 demanded a centesimal scale in moderate potency with infrequent to frequent repetition and I.R. in infrequent repetition, while Case 2 required 50 millesimal potency with frequent repetition and I.R. also in frequent repetition. It reflects the understanding of assessments of susceptibility, the need for different scales, and the role of I.R. in epilepsy management. The presentation of epilepsy with co-morbidities in cases reflects the state and stage of pathology. That understanding helps to plan the therapeutic problem definition and resolution. Its impact on deciding the possibility to tapper/withdraw/continuation of AEDs in epilepsy management and also assess the scope and limitation of homoeopathy. In Case 1, child-free from seizures and AED, and improvement is possible in cognitive and autistic behaviour, while in Case 2, reduction of seizures without modification in AEDs and improvement is possible in cognitive as well gross motor function. It reflects homeopathy helps to stabilise the susceptibility so it leads to a reduction of seizures, withdrawal/stabilise doses of AEDs, and improved functional capacity. In Case 1, improvement in co-morbidity is possible with minimal therapy sessions, while Case 2 demanded frequent therapy sessions. That reflects the understanding of the clinical state and stage of diseases. Through this approach, holistic care is possible and improves the quality of life of the child and the parents as well.

CONCLUSION

The cases reflect the concept of a homoeopathic individualised and integrated approach that helps in the holistic management of epilepsy in children with/without co-morbidities. The cases reflect the importance of case-taking, observation, and understanding of various types of epilepsy, which helps in the understanding of comprehensive diagnosis for management. That focuses on the importance of the knowledge of physicians [Aphorism 3]. The concept of assessment of susceptibility and sensitivity helps in the selection of scale and posology. Moreover, focusing on the sizing of the case helps in the selection of the most similar remedy as well as potency with repetition at an appropriate time. The therapeutic problem definition and therapeutic problem resolution’s assessments, helps in formulating follow-up criteria in such cases. The study of follow-ups reflects the importance of remedy response evaluation and understanding the role of deep-acting as well as intercurrent remedy. I.R. hastens the action of deep-acting remedies and facilitates the process of recovery. Homoeopathy helps control the need for AEDs and the discontinuation of AEDs in cases of epilepsy with the integration of specialists. Homoeopathy and rehabilitation play a crucial role in improving the child’s functioning capacity and modifying the quality of life of the child as well as the parents. Through the cases, understand the scope and limitations of homoeopathy in the management of epilepsy with/without co-morbidities in children.

Acknowledgment

The authors would like to thank Dr. Dilip Nandha for guidance in the preparation of documents.

Ethical approval

The Institutional Review Board approval is not required.

Declaration of patient consent

Patient consent not required as patient identity is not disclosed or compromised.

Conflicts of interest

There are no conflicts of interest.

Use of artificial intelligence (A.I.)-assisted technology for manuscript preparation

The authors confirm that there was no use of artificial intelligence (A.I.)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using A.I.

Financial support and sponsorship

Nil.

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