Minutus

Hoping anyone might have clues as to what this is about.
I'm treating a friend with epilepsy. There are many, many things about her
case that confuse me, but here's a medical aspect I'm wondering about.

Her seizures began at age 23, and were at first spaced many years apart, but
with decreasing internals, and the last three were only a month apart. She
recalls what she now believes to have been petit mal seizures beginning in
childhood.

This past year she had EEG studies done, and her doctor expressed great
surprise at the tracings, pointing out some pattern or other that he said is
usually seen only in *adolescent* epileptics; he had never seen nor, I
gather, heard of the pattern in an adult (she is nearly 50).

Does anyone have any familiarity with what this might be?
She has many other health issues too, and I'd like to have a better
understanding of what's going on, what might be triggering the seizures, and
their present increase in frequency. She is presently doing well on nat-m,
but that did not prevent the latest seizure, one month after the prior, and
that concerns me!

Any clues, ideas????

Thanks,
Shannon

Adolescent epilepsy is often expected to 'burn out' but at 23 she would be
beyond that age anyway. But you say she had petit mal as a child - this is
where the case begins. There is a mass of information available by usng any
search engine on the various 'types' of epilepsy. Her increased frequency
could be due to incompatible drugs - such as the contraceptive pill - even
homeopathic remedies. As well as getting to know as much scientific
knowledge about seizures you have to keep taking the case for knowledge.

Joy
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It may be pointless being on the pill with epileptic allopathic medication as a friend of mine had 3 children that way!!
Regards
Rochelle
www.rochellemarsden.co.uk
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Hi Joy,

Thanks for your thoughts (and also thanks to those that wrote off-list).
Just tonight she sent me an article apparently describing her type of
epilepsy, and it looks as tho your thought re "incompatible drugs: was right
on target (yuk). The article says that this type of epilepsy is often
"wrongly diagnosed [as] "complex partial seizures" (partial epilepsy), which
results in a poor choice of medications such as, for example phenytoin
(Dilantin), carbamazepine (Tegretol), or gabapentin (Neurontin)," and that
these drugs can actually make the seizures worse. And in fact this
increased frequency came on very suddenly, after her hospitalization and
commencement of the (apparently inappropriate) drugs. Oh, ouch...

Present situation is that nat-m (LM-1) has been helping her a great deal in
many ways (she feels much better emotionally, sounds much better, has more
energy) BUT has not prevented her from having (gulp) two more seizures in
the past week. In view of this I had her stop the remedy for a few days,
just in case she's overdosing (she had been taking it daily, which could
well have been too often). (I had chosen that remedy on the basis of a very
strong presenting mental/emotional picture, plus its relationship to Ignatia
which had helped her enormously just prior, plus her life situation which is
a very, very "grief remedy" sort right now. Plus lingering effects of
several head injuries.

Any further thoughts welcomed!
Below I've copied the article she sent about this type of epilepsy.

Thanks again!
Shannon

* * * *

IDOPATHIC GENERALIZED EPILEPSY
Idiopathic generalized epilepsy, abbreviated IGE, is a type of epilepsy that
has very distinct features. It is also called "primary" generalized
epilepsy. The term "idiopathic" is misleading, because it usually means
"cause unknown," which is not true here. Idiopathic generalized epilepsies
have the following characteristics:
*
They are genetic and not caused by any brain physical abnormality. This
means that the brain is anatomically normal.
*
They basically represent a genetic low threshold (or high susceptibility)
for seizures
.
*
Thus, there is often, but not always, a family history of epilepsy. (If ev-
eryone had 50 siblings, patients with IGE would more often have a family
member affected).
*
For some specific types (for example, juvenile myoclonic epilepsy) the
chromosome and gene have even been identifi ed. Others will almost cer-
tainly be identified.
*
They tend to begin during childhood or adolescence, although they may not
be diagnosed until adulthood.
*
People with IGE have normal intelligence, normal neurological examina-
tion, and normal MRIs.
*
Although they are clearly genetic, they are not transmitted predictably
like, for example, hemophilia or cystic fibrosis.

Type of seizures:
Patients with IGE have one or more of 3 types of (primary generalized)
seizures: myoclonic, absence and generalized tonic-clonic seizures.
*
One type may be the only or main type in a given patient.
*
Generalized tonic-clonic seizures are convulsions of the whole body lasting
1-2 minutes, and are the most common and most dramatic type of seizures.
[N.B.: This is the type my friend has.]
*
Absence seizures are brief staring spells with arrest of activity, often
with eye fluttering, which last just a few seconds. [NB: She had these in
childhood.]
*
Myoclonic seizures are very brief isolated body jerks that tend to occur in
the morning.

How do we make the diagnosis?
*
It may be diffi cult, and at times impossible, to make a precise diagnosis
of epilepsy type (beyond just "epilepsy" or "seizure disorder").
*
Age of onset is usually early in life.
*
The types of seizures seen in IGE are described above.
*
Intellectual functions, neurological exam, and imaging (MRI) are normal
in IGE.
*
The
electroencephalogram (EEG) is the only definitive test to confirm the
diagnosis of IGE. Unfortunately, a single EEG is often normal in patients
with epilepsy, in which case it does not help. When abnormal, the EEG
in IGE is very characteristics, with various combinations of generalized
spike-wave complexes, spikes, or polyspikes, sometimes triggered by
fl ashing lights (photosensitivity) (see figures).

Subtypes of IGE:
Depending on age at onset, predominant seizure type(s), and EEG findings,
several subtypes of IGE exist:
*
Childhood absence epilepsy: typically begins between 4 and 10 years of
age. The main seizure type is typical absences, which are brief (about 10
seconds), but occur frequently (usually >10 daily). About 50% of patients
also have generalized tonic clonic seizures seizures, and very few also have
myoclonic seizures. EEG shows a very characteristic pattern called gener-
alized 3 Hz spike-wave complexes.
*
Juvenile myoclonic epilepsy (JME) typically begins in adolescence (12-18
years), and is characterized by myoclonic jerks, particularly in the morn-
ing. EEG shows a very characteristic pattern called generalized polyspikes,
often with generalized 3 Hz spike-wave complexes.
*
Epilepsy with grand-mal seizures consists of generalized tonic clonic sei-
zures mainly, which may be more frequent in the morning. EEG can show
either of the above patterns or generalized spikes.

Why is it Important to know exactly which type of epilepsy you have?
*
Because treatment options are not exactly the same for IGE and partial (fo-
cal) epilepsies. Some drugs work better than others for this type of
epilepsy (see below). Also, surgery is never an option for this type of
epilepsy.
*
Because prognosis is very different.
o
The IGEs are usually easy to treat, i.e., they respond to medications
in about 90% of patients.
o
Many IGEs are outgrown in young adulthood, with the exception of
JME.
*
Many patients with IGE are wrongly diagnosed with "complex partial
seizures" (partial epilepsy), which results in a poor choice of medications
such as, for example phenytoin (Dilantin), carbamazepine (Tegretol), or
gabapentin (Neurontin).

[This was my friend's initial diagnosis, and she was first placed on
Dilantin, then Tegretol, neither of which was tolerated or effective.]

Treatment
*
Many drugs are available to treat epilepsy, but they are not all appropri-
ate for this type of epilepsy.
*
Phenytoin (Dilantin), carbamazepine (Tegretol), gabapentin (Neuron-
tin), tiagabine (Gabitril), oxcarbazepine (Trileptal) are excellent drugs
for partial (focal) seizures, but do not work well in IGE. In fact they
can make some seizures worse. This is unfortunate because phenytoin
(Dilantin) and carbamazepine (Tegretol) are the most often prescribed
drugs for seizures.

The classic drug of choice for IGE is valproic acid (Depakote).
*
For patients (usually children) with absence seizures only, ethosuximide
(Zarontin) is also an option.
*
Other medications can be used in IGE. Phenobarbital and primidone
(Mysoline) are old drugs that tend to cause sedation. The following drugs
may well be an option too, although they are not offi cially approved for
this: lamotrigine (Lamictal), topiramate (Topamax), levetiracetam (Kep-
pra), zonisamide (Zonegran).

How long does treatment last?
*
With the exception of juvenile myoclonic epilepsy (JME), these are often
outgrown (roughly 50% of the time) in young adulthood, so weaning
may be tried.
*
JME is the only type that is not outgrown, so attempts to stop drugs in
JME usually fail.

Other treatments:
Non-drug treatments like the ketogenic diet and vagus nerve stimulation are
almost never considered in IGE, because response to medications is usually
excellent. As mentioned above, epilepsy surgery is never an option for IGE.

Additional reading
(deleted; if anyone wants the list, just ask (off-list)!)

on 3/7/03 7:54 AM,

Dear Shannon, I think my approach to this would be to really sort out her
allopathic drugs and ascertain if she would feel happier about continung
with them or not. Being away from the these drugs will give a clearer
picture. This might have to be done slowly depending on how she feels about
it and how long she has been on them. But at the momnt they seem to be
harming her more than helping her. But it would be important to offer her
homeopathic help if she does decide to stop taking the drugs.

I would also take extremely detailed notes about the seizures, just on their
own and see if any remedy comes up. It is possible that a specific remedy
that fits the seizure picture will help her get through the next phase as
she comes of the drugs. In a way this is a bit like treating someone with
chronic asthma, for example, - where they need to be taking the chronic
remedy for the underlying cause and tendency but another remedy for the
acute attacks - a long, slow but gentle process but with time brings about
total cure.

If she is really and truly doing very well on the Nat Mur then this should
continue to be the case, perhaps, as you say, dosage needs to be sorted.

By the way, you say she has lingering symptoms from head injuries - don't
forget Nat Sulph not only for the injuries but also for the seizures.

Hope this helps, best wishes, Joy
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Thanks, Joy!

She has not really had a lot of drugs yet, as she started them only last
August (I think). Since then all dosages have been very low -- "barely
within the therapeutic range", because of side-effects; she has taken
herself off on several occasions (due to side effects), and changed drugs at
least twice, again because of side effects. She is about to start yet
another drug, supposed to be more appropriate for this type of problem.

I don't know where to begin sort out drug effects, with so many changes.
But the only things that have really changed during this time have been (a)
increased frequency of seizures (maybe from the inappropriate drugs, and
maybe, as she thinks, from hormonal changes of approaching menopause...
Sheesh, can we find a few more complicating factors here?), and (b) improved
M/E state (from Ign. and then Nat-m), and (c) some specifics of the seizures
themselves have changed -- e.g. she used to always go over backwards, but in
the last two, she went down face-first. What do I do with that (she said
helplessly)... I assume that change is to do with the drug effects, but
should I use or discard it? Does it matter???

Some time back I repped the then-regular events of her seizures, and it
seemed to point to oena.

MOUTH; BITING; tongue; convulsions, during*
BLADDER; URINATION; involuntary; convulsions, during
GENERALITIES; CONVULSIONS, spasms; epileptic; before epileptic paroxysm,
aura; absent
SLEEP; DEEP; convulsions, spasms; after
GENERALITIES; CONVULSIONS, spasms; falling, with; backwards

(Only Oena runs thru all of these.)

Looking thru the rubric extraction there's much there that seems to suit
(maybe). I haven't known what might be a reasonable way to try this (or
whether it would be justified) since she has no warning before a seizure.

Before these last two (three?), she was very, very, very spacey; so this
*might* be her aura now, but that may also be a drug effect. The earlier
seizures were during times of extreme stress and so may have had some
"unclarity" attached, but she hadn't observed that pattern...

So long as she is happy on nat-m I'm not eager to change, BUT I'm wondering
if it would be possible to more directly help the seizures? Might it be
reasonable to have to take Oena. intercurrently? (Feelin' out of my depth
again...)

Again, thanks so much!
Shannon
on 3/12/03 8:10 AM, Joy Lucas at joylucas_speaktv@hotmail.com wrote:

Hi Shannon
I have been treating someone for the past 6 months who has been having petit mals for 40 years. When I first saw her, she was having around 20 per month. Within one month of beginning treatment she was down to 7 or 8 and now is down to 2 or 3. She is on rather strong medications and is too nervous to go off them. Some of her symptoms are likely due to side effects of the medication eg., trembling and tummy troubles, however I decided to go ahead anyway and see what happened. She has only had two remedies in the time period, but she takes 1 dose every 3 days. She has never proved the remedy and has made good progress.
I read about the treatment of epilepsy, and found that it is considered difficult to treat by many. However, I did find some good info from Dr. Banerji's notes and books re the treatment, and seeing that was the only solid info I could find, took my lead from there - hence the frequency of the treatment.

I put your rubrics into my program and apart from Oena, I think you should look at Art-v. This was next for consideration in the rep, and is particularly indicated if there is any dullness of mind after attacks. Interestingly, it will improve both the mental faculties and the convulsions. In my notes, it also says " it can antidote Sodium Valproate and can be used to withdraw people from anticonvulsive drugs". It is recommended in 1x or 6c. It acts better during frequent and acute attack than in pause periods of attacks which can occur at very long intervals of weeks or months. I have quite a few different grouping of symptoms for this remedy and will send them to you if you feel you would like to see them.

Hope this helps

Regards

Robyn

"Each progressive spirit is opposed by a thousand mediocre minds appointed to guard the past" (Maurice Maeterlinck)

Thanks Robyn,

I'd love to see the sx groupings.
The MM (little that I've read so far) does sound very to-the-point. Her
seizures were not *originally* brought on by head trauma or grief, but both
could well be players at this point.

Is there a particular reason why you think it seems more indicated than
oena, altho it doesn't appear in the "falling backwards" and "deep sleep
after" rubrics? (She typically sleeps deeply after the seizure, and then
also has (dullness and?) confusion for some days afterwards.)

I'll read more on art-v, and thanks for the thought!
Shannon
on 3/12/03 5:40 PM, Robyn at folco@tpg.com.au wrote:

Dear Shannon,

you wrote..
the hormonal changes could be very important and need to be incorporated
into the case.
also..

some specifics of the seizures themselves have changed -- e.g. she used to
always go over backwards, but in the last two, she went down face-first.
What do I do with that?

I would stick with the seizure type as it was - regularly. It could be too
much of a coincidence that her seizures change when the drugs change. If
they become more frequent on a regular basis and she is off that last drug
then you might need to add the frequency to the case. This is why is would
be such a good idea to work out a safe and secure drug withdrawal procedure
for her - to clear the picture.

Also..

To this I would add, seizures sudden - which oenanthe is in.
Also..

Yes, I would agree with the inter-current or occasional use of Oenanthe.
Perhaps one a day or every other day or whenever she feels the need, once a
week even. Apparently the tincture has been successful!! As long as you are
convinced of this as a remedy for her, it would be worth trying. It is
possible it might the simillimum for the whole case.

As I wrote to you before Oenanthe is an interesting rx - the seizures are
very much related to the menstrual cycle (or lack of sometimes) and even
during pregnancy. This might link in with her hormonal changes. There are
lots of skin conditions. Also the seizure type is very specific - worth
reading up in many MM's. They are usually very frequent seizures and they
cry out as they fall backwards. Foam at the mouth, face twitches a lot, they
feel as insects are crawling over their skin, their hands are clenched
during seizures.

They have a delusion that they are carried to an elevation (if you can work
in a connection of ideas around that in her case). They also have a
sensation as if mesmerised - these aspects indicate to me someone who is
under the authority of another. There is also a delusion of flying (wanting
to escape that authority?) and attempts to escape. They have problems with
their relatives - refuse to recognise them - so that might be an aspect of
the case as well?

Hope this helps.

best wishes, Joy

Dear Shannon
I just came across all these seizure posts and with interest have
studied all the replies. It occurs to me that perhaps your patients
sexual history has not been explored as I see pts that have seizures
directly related to sexual activity and sexual anxiety. Both usually
equal the wrong partner and sometimes a seizure occurs during
masturbation. Young sexual abuse cases can present petit to grand
seizures and is appropriate as a way to survive. Teens and twenties
are stressful in poor relationships, and the fifties, well there was
the mention of menopause (oestrogen glitchs) so maybe something there.
As these topics are still taboo it is good to pry quietly. I would
not be to interested in the EEG etc. I am also not saying that this
is so, just perhaps overlooked in the diagnosis. Also take a deep
look at bufo (low dose) as preventative-cure.
Thanks for the opportunity to share.
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wrote:
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