Seizures

//Western Diagnosis:// Sudden, brief attacks of altered consciousness, motor activity, sensory phenomena, inappropriate behavior --recurrent, paroxysmal --xs discharge of cerebral neurons

Etiology
1. symptomatic a. cause identified b. hyperpyrexia, CNS infections, metabolic disturbances (hypoglycemia), toxic, cerebral hypoxia, neoplasms, congenital brain defects, cerebral edema, cerebral trauma, anaphylaxis, cerebral infarct or hemorrhage 2. idiopathic a. no obvious cause b. 75% of all seizures in young adults c. begins between ages of 2-14 d. before age 2 - developmental defects, metabolic disturbances, birth injury e. after age 25 - tumors, trauma f. focal brain disease can cause seizures at any age

Classification
1. partial a. specific sensory, motor, psychic change that reflects the affected part of the brain 2. generalized a. aura often first b. motor and consciousness affected

Signs & Symptom
a. simple partial (focal) i. specific sensory, motor, psychomotor phenomena without loss of consciousness - aura is one
 * partial**

i. focal sxs begin in hand or foot and march up extremity ii. may be local or proceed to generalized
 * jacksonian**

i. 1-2 minute loss of contact with surroundings: purposeless movements, unintelligible sounds, staggering ii. no understanding iii. structural pathology
 * complex partial (psychomotor)**

loss of consciousness and motor function
 * generalized**

//absence (petit mal)// i. generalized ii. 10-30 second loss of consciousness with eye or muscle flutterings iii. stops activity and then resumes it after attack is over iv. often when sitting quietly v. genetic vi. **never** begin after age 20

//grand mal (tonic-clonic)// i. generalized ii. occ aura iii. loss of consciousness iv. tonic-clonic contractions of muscles of extremities, trunk, head v. 2-5 minutes vi. postictal state - sleep, HA, muscle soreness

//atonic// i. brief, generalized ii. in children iii. complete loss of muscle tone and consciousness

//myoclonic// i. brief, quick jerks ii. may be repetitive iii. no loss of consciousness

//infantile spasms// i. sudden flexion of arms and trunk with extension of legs ii. last a few seconds, several times daily iii. only in first 3 yrs of life iv. developmental abnormalities

//febrile// i. 3 months to 5 yrs old ii. fever iii. in 4% of all children - 2% of those develop epilepsy

Diagnosis
1. hx - family, trauma, infection, toxic exposure 2. serum glucose, CBC, chem screen 3. CT scan, MRI, EEG

Treatment
1. prevent injury during convulsion 2. identify cause if possible and then tx

anticonvulsant agents
a. phenytoin (dilantin) b. phenobarbital c. clonazepam d. carbamazepine e. primidone f. valproate

Acupuncture
KI-1, GV-26

Ayurvedic Recommendations
Coleus Forskohlii

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Definition:
A group of disorders recognized by chronic, recurrent, paroxysmal changes in cerebral function; and brief attacks of altered consciousness/motor activity/sensory phenomena due to abnormalities of the electrical system of the brain. Also known as "epilepsy".

Etiology:
Epilepsy is defined as symptomatic or idiopathic. At least 75% of adult sufferers, and a small minority of children, have idiopathic epilepsy that does not lend itself to specific treatment leading to cures. The condition can occur at any age from a number of causes:

• From 1-2 years old (Infants): Paranatal hypoxia and ischemia; intracranial birth injury; acute infection with high fever; genetic disorders; metabolic conditions (hypoglycemia, hypomagnesemia, etc.).

• 2-12 years old (Children): Idiopathic; acute infection (especially if have similar history as an infant); trauma.

• 12-18 years old (Adolescent): Idiopathic; trauma; alcohol or drug withdrawal; arteriovenous malformations.

• 18-35 years old (Young adults): Trauma; alcoholism; brain tumor.

• >35 years old (Older adult): Brain tumor; cerebrovascular disease; alcoholism, metabolic conditions (uremia, hepatic failure, etc.).

Seizure classification: • Partial or focal seizures. • Primary generalized seizures. • Unilateral seizures. • Unclassified epileptic seizures.

Somatic therapies:
• daily outdoor exercise (Kellogg, p. 1056) • contradication: strenous activities

Nutrition:
therapeutic foods: • foods that rid internal Wind, clear Heat • foods rich in Vitamin B6, mg • for patients using Dilantin, folic acid-rich foods • increase foods rich in Calcium, Phosphorus, Manganese, Sulfur, Iodine, tryptophan (Jensen, p. 63) • egg yolk, kale, celery, fish, raw goat's milk, veal joint broth, cod roe, rice polishings, brewer's yeast, nutritional yeast (Jensen, p. 63)

fresh juices: • celery, carrot, prune (Jensen, p. 63) • prune and rice polishings (Jensen, p. 63) • raw goat's milk and 1 tsp. sesame, sunflower, or almond butter, 1 tsp. honey and sliver of avocado (Jensen, p. 63) • black cherry and egg yolk (Jensen, p. 63) • carrot celery, spinach, and parsley (Walker, p. 136) • spinach (Walker, p. 136) • carrot and spinach (Walker, p. 136) • carrot, beet, and cucumber (Walker, p. 136)

specific remedies: • boil tea from cucumber vines and drink (Ni, p. 35)

avoid: • meat, alcohol, hot sauces, spicy foods, fried foods, fatty foods, rich foods, salty foods, coffee, caffeine, sweet foods and sugar, alcohol, cow's milk and other dairy products, white bread, refined foods, processed foods, catarrh-forming foods: tofu, meat, ice cream, shellfish

Botanicals
• Adonis vernalis (toxic): see formulae below (Ellingwood, p. 234; Felter, p. 156) • Atropa belladonna (toxic): associated with congestive symptoms (Felter, p. 241) • Cimicifuga racemosa: seizure associated with menstrual failure; child after pertussis subject to periodic choreic seizures (Felter, p. 469) • Conium maculatum (toxic): (Ellingwood, p. 104) • Datura stramonium (toxic): followed by mania (Felter, p. 659) • Gelsemium sempervirens (toxic): especially with acute cerebral hyperemia, convulsions with cramping rigidity of muscles (Ellingwood, p. 77; Felter and Lloyd, p. 922) • Hyssopus officinalis: has been used for petit mal (British Herbal Pharmacopoeia, p. 116) • Lobelia inflata (toxic): may add Capsicum frutescens: spasms of all characters, from infantile convulsions to puerperal eclampsia, convulsions due to worms (Ellingwood, p. 238; Harper-Shove, p. 172) • Passiflora incarnata: lessens the number of paroxysms, not useful to stop seizure in progress (Ellingwood, p. 108) • Paeonia officinalis: convulsions of childhood; convulsion disorders (Ellingwood, p. 129) • Scutellaria lateriflora: grand mal, see formulae below (Ellingwood, p. 124; British Herbal Pharmacopoeia, p. 194) • Solanum carolinense (toxic): all forms of "epilepsy," menstrual (Ellingwood, p. 127; Harper-Shove, p. 27) • Strychnos ignatii (toxic): according to indications (Felter, p. 425) • Valeriana spp.: chorea, mild spasmodic movements (Felter, p. 685) • Verbena officinalis: generalized seizures (British Herbal Pharmacopoeia, p. 228) • Viscum album (toxic): (Ellingwood, p. 153)

Chinese Formulae
• Bos and Curcuma F. (An Gong Niu Huang Wan); Hou Yan Wan (patent): Heart Agitated by Phlegm Fire: infantile convulsions (Bos and Curcuma: Hsu, 1980, p. 330; Yeung, p. 31; Bensky and Barolet, p. 416; Hou Yan Wan: Zhu, p. 182) • Da Ding Feng Zhu: Liver Yin Xu (Deficiency) with Liver Wind Stirring: muscle spasms with alternating flexion and extension of the extremities (Yeung, p. 63; Bensky and Barolet, p. 407) • San Jia Fu Mai Tang: Yin Xu (Deficiency) (with or without Liver Yang Rising) causing Liver Wind Stirring: spasms, loss of consciousness, quivering fingers, feverish palms and soles, dizziness and vertigo, tinnitus, dry throat. (Yeung, p. 185; Bensky and Barolet, p. 405) • Zizyphus C. (Suan Zao Ren Tang) (in children); She Dan Chen Pi San (patent): Liver Xue Xu (Blood Deficiency) with Heart Fire Blazing: Shi (Excess) conditions affecting Heart: epilepsy, seizures; may be taken with other seizure medications such as dilantin or phenobarbitol (Zizyphus C.: Flaws, p. 129, Hsu, 1980, p. 355; Yeung, p. 225; Bensky and Barolet, p. 379; She Dan Chen: Zhu, p. 80) • An Gong Niu Huang Wan (patent): Heart Agitated by Phlegm Fire: seizures; children's spasms due to high fever (Zhu, p. 129) • Yan Hu Su Zhi Tong Pian (Corydalis Yanhusus Analgesic Tablets) (patent): Xue Yu (Blood Stasis): relaxes smooth and striated muscle spasms (Zhu, p. 232) • Tian Ma Mi Huan Jun Pian (patent): Liver Wind Stirring: epileptic seizures (Zhu, p. 319) • Ci Zhu Wan (patent): Kidney and Heart Not Communicating: best if used in combination with other medicines (Zhu, p. 329) • Aquilaria and Gastrodia C.: Heart Misted by Cold Phlegm (Hsu, 1980, p. 370; Dharmananda, 1986, p. 345) • Gastrodia 9 (patent): Liver Wind Stirring (Dharmananda, 1990, p. 83)

Acupuncture
after assessing the person and palpating, consider these patterns: Heart Agitated by Phlegm Fire; Heart Misted by Cold Phlegm; Liver Xue Xu (Blood Deficiency) with Heart Fire Blazing; Liver Yin Xu (Deficiency) with Liver Wind Stirring; Liver Wind complicated by Turbid Phlegm; Liver Fire complicated by Phlegm Heat; Liver and Kidney Yin Xu (Deficiency); Spleen and Stomach Xu (Deficiency); Shi (Excess) of Yang Qiao Mai (Yang Motility Vessel), Yin Qiao Mai (Yin Motility Vessel), and/or the Du Mai (Governing Vessel)

» therapeutic note: the diagnostic patterns and treatment approaches for "seizure disorders" were often the same as for "mania" in the traditional literature

» illustrative combinations: • UB-62, SI-3 and SI-2 for seizures (Shanghai, p. 282) • CV-14, GV-14, GV-26, yao qi and PC-6 for seizures (Shanghai, p. 178) • GB-20, yao qi, GV-26 and PC-6 for seizures (Shanghai, p. 146) • GV-15, GV-26, SI-3 and St-40 for seizures (Shanghai, p. 167) • si shen cong, GV-18 and Kd-1: treat Wind epilepsy (Ellis, et al, 1988, p. 398) • Kd-1, UB-15, LI-10, CV-15, CV-12, Lu-11 and CV-14 for epilepsy (Lee and Cheung, p. 298) • CV-15, SI-3, Kd-1, UB-15, GB-35, St-36, Lv-3, Lv-2 and CV-13 for epilepsy (Lee and Cheung, p. 298) • GV-26, LI-4 and GB-34 (also consider PC-6, GB-20 and Kd-1) for convulsions (Lee and Cheung, p. 217) • GV-20, PC-7, Ht-5, Ht-6 and Ht-7 (-): cause normal EEG in grand mal seizures and reduce abnormal spikes in waves (Finkelstein, p. 81) • Ht-7, SI-3 and CV-15: treat the "five epilepsies" (Ellis, et al, 1988, p. 359) • SI-4, Lu-11 (bleed), GV-26 and Kd-1 for convulsions in children (Lee and Cheung, p. 217) • GV-4, CV-8 and UB-60: treat epilepsy in a child • SI-3 and UB-62: open the Du Mai (Governing Vessel) for which seizures are a symptom of Shi (Excess) • UB-62 and SI-3: open the Yang Qiao Mai (Yang Motility Vessel) which transports Yang and for which epilepsy worse during the daytime is a Shi (Excess) symptom and epilepsy worse at night is a Xu (Deficiency) symptom • Kd-6 and Lu-7: open the Yin Qiao Mai (Yin Motility Vessel) which transports Yin and for which epilepsy worse at night is a Shi (Excess) symptom and epilepsy worse during the daytime is a Xu (Deficiency) symptom • GV-20, SI-3, LI-11, GB-34, UB-57, Lv-3, UB-60 and GV-8: treat opisthotonos and spasms of the four limbs (Flaws, 1989, p. 98) • GV-14, GV-8, SI-3, GB-24 (also consider GV-12, LI-4, an mian, Lv-3 and GV-26) for convulsion without fever (Lee and Cheung, p. 217) • GV-16, GB-20, GV-26, GV-14 and yao qi (also consider UB-62, Kd-6 and PC-6; or PC-5 and Ht-7; or Ht-5, LI-4, Lv-3, Sp-6, GB-34, CV-14, CV-12, St-40 and GV-24) for epilepsy; for grand mal exclude Kd-6 in the day and UB-62 in the night (Lee and Cheung, p. 298) • GV-16, GB-20, GV-26, GV-14, yao qi, PC-6, Ht-7 and GV-24 for petite mal (Lee and Cheung, p. 298) • GV-16, GB-20, GV-26, GV-14, yao qi, LI-4, Lv-3, GB-34, Sp-6, GV-20, UB-15, UB-18 for localized seizures (Lee and Cheung, p. 298) • GV-16, GB-20, GV-26, GV-14, yao qi, PC-5, Ht-7, St-40, CV-14 or CV-12 for emotional motor seizures (Lee and Cheung, p. 298) • St-40, CV-14 and CV-12: expand the chest, decrease the Phlegm and treat emotional motor seizures (Finkelstein, p. 22) • GB-20, GV-16, GV-20, LI-11, UB-60 to treat Liver Wind, Wind Injury, and headache (Flaws, 1989, p. 98) • GB-12, UB-18 and UB-19: reduces the upward disturbance of Fire of the Liver and Gall Bladder (Finkelstein, p. 65) • yin tang (bleed), tai yang (bleed), si feng (bleed), shi xuan (bleed); GV-14, GV-12, LI-11 and LI-4 (also consider PC-8, TW-5 and Kd-1) for convulsion with fever (Lee and Cheung, p. 217) • GV-26, PC-6 and Kd-1: open the Orifices (Brain) and resuscitate (Finkelstein, p. 83) • GV-26 and yin tang: resuscitate the mind and open clenched teeth (Finkelstein, p. 83) • GV-26 and PC-9: restore loss of consciousness; resolve stiffness • GV-15, PC-8, Sp-6, Kd-1, Kd-3, CV-12, GB-30, St-36 and LI-4 are the Nine Needles for Returning the Yang (Li, p. 627-628; Ellis, et al, 1988, p. 66) • GV-26, Lu-11, Sp-1, PC-7, UB-62 (hot needle), GV-16, St-6 (warming needle), CV-24, PC-8, GV-23, CV-1 (for males; for females, use a point at the opening of the vagina), LI-11 (hot needle) and hai quan (prick) known as the thirteen Ghost points, these are needled in the order presented for psychosis (madness and insanity) (Shanghai, p. 630); note: in the classical literature madness and epilepsy were often considered as overlapping conditions • GV-15, GV-1, GV-16, GV-17 and GV-28 are the Sea of Marrow points • Lu-10, UB-57, UB-60 for spasms and vertigo (Lee and Cheung, p. 217) • consider treatment for "Internal Dragons" or "External Dragons"; External Dragons: GV-20, UB-11, UB-23, UB-61; Internal Dragons: Master point 1/4" below CV-15, St-25, St-32, St-41; In both treatments, sedate first. If the person and the pulses change, fine. If no change with sedation, then tonify. (Worsley) • CV-14 and UB-15: remove Obstruction of Heart Qi circulation to reduce Fire and ease the Mind (Finkelstein, p. 90) • GB-20 and Lv-2: nourish Yin, reduce Heat of Liver and Gall Bladder, and clear the head (Finkelstein, p. 66)

Homeopathy
• Argentum nitricum: seizures occurring especially at night, after emotions or with the period, preceded by mydriasis and followed by hand-shaking and agitation • Asterias rubens: epilepsy preceded by twitching all over the body • Cicuta virosa: petit mal, occur especially at night; very violent clonic and tonic convulsions of the entire body; triggered or amplified by the least touch, noise, jar, cold and tobacco smoke; often preceded by a stomach aura and fear; during the crisis, the face is congested • Cuprum: tonic and clonic spasm, convulsions and epileptic attacks; aura begins at knees and ascends to hypogastrium, then unconsciousness, foaming and falling; during crises thumbs convulsively flexed towards the palm • Hydrocyanic acid: violent and sudden convulsions, marked cyanosis; cold and blue body and extremities; heart weak and irregular, pulse rapid • Indigo tinctoria: epilepsy with great sadness; flushes of heat from abdomen to head; fit begins with dizziness; aura from a painful spot between shoulders • Lithium bromatum: cerebral congestion and nervosity, insomnia and nervous agitation; epilepsy along with those symptoms • Nux vomica: hypersensitive and hyperreflexive; spasm < all external influences, esp. least touch, noise, light and cold air draft; intense convulsions leading to opisthotonos • Oenanthe crocata: sudden convulsions not preceded by any aura, loss of consciousness sudden and complete; pale face or alternating pale and red; fixed eyes, dilated pupils; thumb flexed inside hand; convulsions of all muscles of face and extremities; weak, irregular, slow heart; < drinking water; deep comatose sleep follows with stertorous respiration • Ranunculus bulbosus: low spirits, stupid; linked to sexual excitation or masturbation; often irritable during preceding days or hours; mydriasis and incoherent speech; aura from the solar plexus or genitals; sweaty face, biting of the tongue, involuntary loss of urine, crisis followed by sleep; < night during sleep, after fear, anger, masturbation

Mind/Body
• Rigid primary process, the unconscious channel of which is movement (unoccupied channel is always where great experiences happen). (Mindell, 1988, p. 63) • Sense of persecution; rejection of life; a feeling of great struggle; self-violence. (Hay, 1984, p. 163)

Chinese psychophysiology: • Liver ~ Gan is the home of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; stores the Xue (Blood); maintains smooth flow of Qi and Xue (Blood); controls the muscles, especially their contractility; opens into the eyes; and expresses itself in the nervous system; and reflects emotional harmony and movement. » Healthy expressions are kindness, spontaneity, and ease of movement. » Liver Xu (Deficiency) signs include impotence; frigidity; pain in thighs, pelvic region, and throat; ready tendency to "the blahs" (Seem, p. 28); timidity; depression; irritability; vertigo; pruritus; dry eyes, skin, and/or tendons; asthma; aching at the waist; hernia; and difficulty raising head up and down. Liver Yin Xu (Deficiency) predisposes to the Shi (Excess) conditions of Liver Wind and Liver Fire Blazing. » Liver Shi (Excess) signs include discontent; anger; pain in lumbar region and genitals (Seem, p. 28); muscular tension; excessive sex drive; insomnia; moodiness; excitability; genital diseases; red, tearing eyes; compulsive energy; and bitter taste in the mouth. Chronically suppressed anger can implode and give rise to Fire in the Liver and Gall Bladder with symptoms of irritability, bitter taste, headaches, etc. » Liver Wind derives from Liver Yin Xu (Deficiency) and/or Liver Xue Xu (Blood Deficiency) and their subsequent inability to embrace the Yang, and can manifest as joint stiffness, dizziness, tremor, paralysis, convulsions, rashes, itching, and neurological problems. Wind can also be internalized after exposure to inclement, especially windy, weather and any concomitant influences of Damp, Cold, and/or Heat.

• Heart ~ Xin houses the Shen (Spirit) and reveals itself through the brightness in the eyes; governs Fire and Heat; rules the Xue (Blood) and its vessels and directs the circulation; opens into the tongue and controls speech; and relates to the integration of the organs and the personality. » Healthy expressions are warmth, vitality, excitement, inner peace, love, and joy. » Heart Xu (Deficiency) signs include sadness; absence of laughter; depression; fear; anxiety; shortness of breath (Seem, p. 28); cold feeling in the chest and limbs; palpitations; cold sweat; inability to speak; memory failure; nocturnal emissions; and restless sleep. Chronic Yin Xu (Deficiency) predisposes to Empty Fire, acute and chronic. » Heart Shi (Excess) signs include false or facile laughter; sobbing; agitated spirit; insomnia (Seem, p. 28); frightful dreams; anxiety; tongue feels numb and heavy; heavy chest; hot sweat; and orange-colored urine. » The Heart is the Emperor of the bodily realm so that when the Heart is disturbed all the other organs will be disrupted.

• Pericardium ~ Xin Bao is the Minister who protects the Heart, the Emperor, and maintains the order of the Heart energy; and as such may be adversely affected by emotional stresses internally or invasion of Heat externally. The Pericardium is said to be the origin of joy and sadness. » Healthy expressions are joy, happiness, and healthy relationships. » Weakness, dysfunction, and illness are associated with confusion, delirium, nervousness, and psychosis.

• Spleen ~ Pi governs digestion and manifests in the muscle tissues; transforms food into Qi and Xue (Blood); governs the Xue (Blood); resolves Dampness and Phlegm; and relates to the ability to assimilate, stabilize, and feel centered and balanced. » Healthy expressions are fairness, openness, deep thinking, and reminiscence. » Spleen Xu (Deficiency) signs include slightness (deficient "form"); abundant elimination; morning fatigue; cold, wet feet (Seem, p. 28); abdomen taut and distended like a drum; craving for sweets; flatulence; nausea; mild edema; memory failure; heavy feeling in legs; pale lips; loose stools; and muscular weakness; and, indirectly, obesity. Unresolved Spleen Xu (Deficiency) predisposes to Spleen Shi (Excess), particularly Phlegm, as the Spleen's functioning declines. » Spleen Shi (Excess) signs include heaviness (excess "form"); large abdomen; great sighing; sadness; obsessions and nightmares (Seem, p. 28); abdominal pain; irregular appetite; stickiness in the mouth and on lips; red lips; chest congestion; fatigue; and constipation. Phlegm Shi (Excess) derives from Spleen Yang and/or Qi Xu (Deficiency). » The excessive use of the mind in thinking, studying, concentrating, and memorizing over a long period of time tends to weaken the Spleen and may lead to Xue Yu (Blood Stasis). This also includes excessive pensiveness and constant brooding. (Maciocia, p. 241) Likewise, inadequate physical exercise and excess consumption of sweet and Cold foods will also deplete the Spleen. Environmentally, the Spleen is highly susceptible to attack from external Dampness and Cold.

• Kidney ~ Shen stores Jing (Essence) and governs birth, growth, reproduction, development, and aging; houses the Zhi (Will); expresses ambition and focus; governs Water to regulate body fluids; provides the "Fire of Life" through its Yang functions; provides the nourishing and stabilizing qualities of Yin and Water that balance the Yang and the Fiery qualities of the Heart; produces the Marrow which generates the spinal cord and "fills up" the brain; nourishes the brain to sustain concentration, clear thinking, and memory; carries the constitutional endowment from the parents; and displays the effects of overwork, aging, chronic debilitation or degenerative processes, and extreme stress. » Healthy expressions are gentleness, groundedness, and endurance. » Kidney Xu (Deficiency) signs include indecisiveness; confused speech; dreams of trees submerged under water; abundant sweating (Seem, p. 28); fearfulness; apathy; chronic fatigue; discouragement; scatteredness; negativity; impatience; lumbago; sciatica; and musculoskeletal irritation and inflammation, especially when worse from touch. As always, chronic Yin Xu (Deficiency) predisposes to Empty Heat and/or acute inflammation. » Intense or prolonged fear depletes the Kidney. Often chronic anxiety may induce Xu (Deficiency) and then Fire within the Kidney. (Maciocia, p. 250) Overwork, parenting, simple aging, and a sedentary or excessively indulgent lifestyle all contribute significantly to Kidney Xu (Deficiency).