Help with case please
Posted: Fri Jan 17, 2003 12:33 am
I have a case which I'd appreciate some input on as the picture is quite
distinctive but I've not had much success so far in finding a good enough
reflection of it in the literature. (I have the patient's permission to post
this.)
The patient's life is completely dominated by seizures. She's extremely slow
on waking -- can't talk, can't open her eyes. On a good day she can muster
just enough energy to shower and dress herself but grinds to a complete halt
after that. Medication gets her going just enough to enjoy a reasonable
period before lunch, but following lunch she goes into seizure for a good
3-4 hours, gets a brief respite around 4.30-5.00pm, then continues
throughout the evening. At night it can be even worse though sleeping
tablets give relief.
The seizures are very characteristic. The torso goes rigid and leans
backward. There is no arching as the back is rigidly straight (though the
head draws back slightly). In the days when she could stand, this was
clearly evident. Now she has to lie down so the head gets drawn back to a
greater extent instead. Her eyes are either closed or staring at the
ceiling. She remains fully conscious throughout but can't speak or otherwise
communicate. When she could stand, standing helped -- she used to hang onto
a secure handrail and literally dance about it -- and if she could walk that
was even better and would sometimes abort an attack. That's now impossible.
When she gets warning of an impending seizure she goes to lie down as
otherwise she will fall. As mentioned, the torso goes rigid, as do the left
arm and leg which are fully extended. The fingers are extended while the
toes are curled up. She gets bad cramps in the legs and toes while this is
happening. The right leg is drawn up to the body (this happened even in the
days when she could stand) and the right arm moves violently from the elbow
as if she were karate-chopping something repeatedly. If anyone tries to hold
her arm to stop the movement, they can't. The seizures are extremely violent
and exhausting and she's become quite emaciated. She gets a lot of hot
flushes during all this.
Even in her good moments, she has a tendency to slip into this posture --
her torso goes rigid, the right leg bends and the left leg extends -- and
she's constantly slipping down in her chair as a result. Her symptoms are
generally worse when lying down.
While this overall pattern is pretty consistent, the day-to-day occurences
of seizures and their quality and duration is variable and unpredictable.
The condition has been developing over about 20 years. It started with
migraine headaches < mornings. Then, following a car accident where she was
shunted from behind, she noticed weakness in the fingers of the right hand.
There is a mental picture to go with this, but it's the seizures I'm trying
to pin down at the moment so if anyone recognises their precise character in
a remedy, I'd be very happy to hear about it.
Regards
Wendy
distinctive but I've not had much success so far in finding a good enough
reflection of it in the literature. (I have the patient's permission to post
this.)
The patient's life is completely dominated by seizures. She's extremely slow
on waking -- can't talk, can't open her eyes. On a good day she can muster
just enough energy to shower and dress herself but grinds to a complete halt
after that. Medication gets her going just enough to enjoy a reasonable
period before lunch, but following lunch she goes into seizure for a good
3-4 hours, gets a brief respite around 4.30-5.00pm, then continues
throughout the evening. At night it can be even worse though sleeping
tablets give relief.
The seizures are very characteristic. The torso goes rigid and leans
backward. There is no arching as the back is rigidly straight (though the
head draws back slightly). In the days when she could stand, this was
clearly evident. Now she has to lie down so the head gets drawn back to a
greater extent instead. Her eyes are either closed or staring at the
ceiling. She remains fully conscious throughout but can't speak or otherwise
communicate. When she could stand, standing helped -- she used to hang onto
a secure handrail and literally dance about it -- and if she could walk that
was even better and would sometimes abort an attack. That's now impossible.
When she gets warning of an impending seizure she goes to lie down as
otherwise she will fall. As mentioned, the torso goes rigid, as do the left
arm and leg which are fully extended. The fingers are extended while the
toes are curled up. She gets bad cramps in the legs and toes while this is
happening. The right leg is drawn up to the body (this happened even in the
days when she could stand) and the right arm moves violently from the elbow
as if she were karate-chopping something repeatedly. If anyone tries to hold
her arm to stop the movement, they can't. The seizures are extremely violent
and exhausting and she's become quite emaciated. She gets a lot of hot
flushes during all this.
Even in her good moments, she has a tendency to slip into this posture --
her torso goes rigid, the right leg bends and the left leg extends -- and
she's constantly slipping down in her chair as a result. Her symptoms are
generally worse when lying down.
While this overall pattern is pretty consistent, the day-to-day occurences
of seizures and their quality and duration is variable and unpredictable.
The condition has been developing over about 20 years. It started with
migraine headaches < mornings. Then, following a car accident where she was
shunted from behind, she noticed weakness in the fingers of the right hand.
There is a mental picture to go with this, but it's the seizures I'm trying
to pin down at the moment so if anyone recognises their precise character in
a remedy, I'd be very happy to hear about it.
Regards
Wendy