Epilepsy

=Epilepsy/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

//TCM Pathology:// Epilepsy is a medical condition that produces seizures affecting a variety of mental and physical functions. A seizure happens when a brief, strong surge of electrical activity affects part or all of the brain. One in 10 adults will have a seizure sometime during their life. 200,000 new cases of epilepsy are diagnosed each year. Incidence is highest under the age of 2 and over 65. 70 percent of new cases, no cause is apparent.

Seizures can last from a few seconds to a few minutes. They can have many symptoms, from convulsions and loss of consciousness to some that are not always recognized as seizures by the person experiencing them or by health care professionals: blank staring, lip smacking, or jerking movements of arms and legs.

**Types of Seizures**
There are many different types of seizures. People may experience just one type or more than one. The kind of seizure a person has depends on which part and how much of the brain is affected by the electrical disturbance that produces seizures.

-Generalized seizures (absence, atonic, tonic-clonic, myoclonic) -Partial seizures -Simple -Complex -Nonepileptic seizures -Status epilepticus.

Affect both cerebral hemispheres from the beginning of the seizure. Produce loss of consciousness. Sub-categorized into several major types: -Generalized tonic clonic -Myoclonic -Absence -Atonic
 * Generalized Seizures**

The most common and best known type of generalized seizure. They begin with stiffening of the limbs (the tonic phase), followed by jerking of the limbs and face (the clonic phase).
 * Generalized Tonic Clonic Seizures: (Grand Mal Seizures)**

Are rapid, brief contractions of bodily muscles, which usually occur at the same time on both sides of the body. Occasionally, they involve one arm or a foot. People usually think of them as sudden jerks or clumsiness. A variant of the experience, common to many people who do not have epilepsy, is the sudden jerk of a foot during sleep. First aid is usually not needed, however, a person having a myoclonic seizure for the first time should receive a thorough medical evaluation.
 * Myoclonic Seizures**

Produce an abrupt loss of muscle tone. Other names for this type of seizure include drop attacks, astatic or akinetic seizures. They produce head drops, loss of posture, or sudden collapse. Because they are so abrupt, without any warning, and because the people who experience them fall with force, atonic seizures can result in injuries to the head and face. Protective headgear is sometimes used by children and adults; the seizures tend to be resistant to drug therapy. No first aid is needed (unless there is injury from the fall), but if this is a first atonic seizure, the child should be given a thorough medical evaluation.
 * Atonic Seizures**

Lapses of awareness, sometimes with staring, that begin and end abruptly, lasting only a few seconds. There is no warning and no after-effect. More common in children than in adults, absence seizures are frequently so brief that they escape detection, even if the child is experiencing 50 to 100 attacks daily. They may occur for several months before a child is sent for a medical evaluation.
 * Absence Seizures (Petit Mal Seizures)**

Clusters of quick, sudden movements that start between 3 months and two years. If a child is sitting up, the head will fall forward, and the arms will flex forward. If lying down, the knees will be drawn up, with arms and head flexed forward as if the baby is reaching for support.
 * Infantile Spasms**

In partial seizures the electrical disturbance is limited to a specific area of one cerebral hemisphere (side of the brain). Subdivided into: Simple partial seizures (in which consciousness is retained); and Complex partial seizures (in which consciousness is impaired or lost). Partial seizures may spread to cause a generalized seizure, in which case the classification category is partial seizures secondarily generalized. Partial seizures are the most common type of seizure experienced by people with epilepsy. Virtually any movement, sensory, or emotional symptom can occur as part of a partial seizure, including complex visual or auditory hallucinations. Most seizures end after a few moments or a few minutes. If seizures are prolonged, or occur in a series, there is an increased risk of status epilepticus. The term literally means a continuous state of seizure.
 * Partial Seizures**
 * Status Epilepticus**

Seizures: Diagnostic Methods and Tools
The main tool in diagnosing epilepsy is a careful medical history with as much information as possible about what the seizures looked like and what happened just before they began. Physical examination, especially of the nervous system Analysis of blood and other bodily fluids.

Electroencephalograph (EEG) CT (computerized tomography) or MRI (magnetic resonance imaging) scans may be used to search for any growths, scars, or other physical conditions in the brain that may be causing the seizures. In a few research centers, positron emission tomography (PET) imaging is used to identify areas of the brain which are producing seizures.

-Abnormal EEG -Previous seizure -Driver -Other neurological impairment -Elderly
 * Factors Influencing the Decision to Treat**

-Single seizure -No history -Neurologically normal -Young age -Side effects
 * Factors Influencing the Decision Not to Treat**

Anticonvulsant Rx’s
-Tegretol (Carbamazepine) -Klonopin (Clonazepam) -Valium (Diazepam) -Neurontin (Gabapentin) -Lamictal (Lamotrigine) -Ativan (Lorazepam) -Trileptal (Oxcarbazepine) -Solfoton (Phenobarbital) -Dilantin (Phenytoin) -Lyrica (Pregabalin) -Topamax (Topiramate) -Depakote (Valproate)

Vagus nerve stimulation therapy is another form of treatment that may be tried when medications fail to stop seizures. It is currently approved for use in adults and children over the age of 12 who have partial seizures that resist control by other methods. The therapy is designed to prevent seizures by sending regular small pulses of electrical energy to the brain via the vagus nerve, a large nerve in the neck.
 * Treatment Options: Vagus Nerve Stimulation**

When antiepileptic drugs fail to control or substantially reduce seizures, surgery on the brain may be considered. Although some of the techniques are recent, surgical removal of seizure-producing areas of the brain has been an accepted form of treatment for more than 50 years. Most surgical patients are adults who have fought long and unsuccessful battles for seizure control. However, children with severe seizures are also being treated with surgery.
 * Treatment Options: Surgery**

Used when pharmacotherapy fails to adeqately control seizures. The ketogenic diet forces a child's body to burn fat round the clock; 80% of its calories from fat, the rest comes from carbohydrates and protein. The amounts of food and liquid at each meal have to be carefully worked out and weighed for each person.
 * Treatment Options: Ketogenic Diet**

Doctors don't know precisely why a diet that mimics starvation by burning fat for energy should prevent seizures, although this is being studied. Nor do they know why the same diet works for some children and not for others. Trying to put a child on the diet without medical guidance puts a child at risk of serious consequences. Every step of the ketogenic diet process must be managed by an experienced treatment team, usually based at a specialized medical center.

A child on the diet usually continues taking anti-seizure medicine, but may be able to take less of it later on. If a child does very well, the doctor may slowly taper the medication with the goal of discontinuing it altogether. About a third of children who try the ketogenic diet become seizure free, or almost seizure free. Another third improve but still have some seizures. The rest either do not respond at all or find it too hard to continue with the diet, either because of side effects or because they can't tolerate the food.
 * Ketogenic Diet: Chances of Success**

=Epilepsy Patterns/Xián Zhèng= The symptoms of epilepsy are understood in TCM to result from Liver Wind triggering latent Phlegm, which mists the clear orifices and obstructs the channels.

Identifying Organ Involvement during Interictal Stage
Good history taking during periods of remission is essential to identify patterns of organ involvement, such as Spleen Qi Deficiency with excessive Phlegm, and Liver and Kidney Yin Deficiency.

Differential Diagnosis
Four disorders in TCM share the common symptom of loss of consciousness; they can be differentiated as follows:
 * Epilepsy:** during the seizure, the subject may fall with a loud cry. Additional manifestations include convulsions and drooling of white froth; subject recovers within seconds or minutes; sequelae are absent during remission.
 * Wind Stroke:** characterized by a sudden, silent fall accompanied by facial paralysis, hemiplegia, and weakness or numbness on the affected side of the body with a slow recovery of consciousness; various degrees of sequelae common after restoration of consciousness.
 * Syncope:** additional manifestations often include pale complexion and frigid extremities; convulsions are not present.
 * Hypertonicity disorder:** nuchal rigidity is the primary symptom; marked by tonic contractions of voluntary muscles or, in severe cases, opisthotonos with high fever, a prolonged period of unconsciousness, and difficult recovery.

Treatment Principles
Given the paroxysmal, transient, yet recurrent nature of epilepsy, a treatment strategy should be developed based on the stage of the disease in the pattern presenting at that time: Focus on the branch by extinguishing Wind, eliminating Phlegm, opening the orifices, and arresting contractions. Focus on the root by strengthening the Spleen, transforming Phlegm, nourishing the Liver and Kidney, nourishing the Heart in calming the Spirit
 * Ictal Stage (during or immediately following):**
 * Interictal Stage:**

Profusion of Phlegm-Fire
//Mild Presentation:// a. stopping activities abruptly; dropping objects suddenly b. forward bending of the neck c. staring upward d. after consciousness returns, patient does not recall incident //Severe Presentation:// a. falling down suddenly, sometimes preceded by a scream b. loss of consciousness c. convulsions d. frothing mouth e. after consciousness returns, patient feels fatigue, may have headache, and does not recall incident [Long Dan Cao (Gentian Root) 6g, Huang Qin (Scutellaria Root) 9g, Shan Zhi Zi (Gardenia Fruit) 9g, Ze Xie (Alisma Tuber) 12g, Mu Tong (Mutong Stem) 9g, Dang Gui (Tangkuei) 3g, Che Qian Zi (Plantago Seed) 9g, Sheng Di Huang (Rehmannia Root) 9g, Chai Hu (Bupleurum Root) 6g, Gan Cao (Licorice Root) 6g] + [Fa Ban Xia (Processed Pinellia) 9g, Zhi Tian Nan Xing (Arisaema Root) 6g, Chen Pi (Tangerine Peel) 9g, Zhi Shi (Unripe Bitter Orange) 9g, Fu Ling (Poria) 12g, Ren Shen (Ginseng) 6g, Shi Chang Pu (Acorus Root) 9g, Zhu Ru (Bamboo Shavings) 9g, Sheng Jiang (Fresh Ginger Root) 6g, Gan Cao (Licorice Root) 3g]
 * Main Syptoms:**
 * Additional Symptoms:** constipation, agitated emotional state, irritability, insomnia, dry mouth, bitter taste
 * Tongue:** Red, yellow greasy coat
 * Pulse:** Rapid, wiry, slippery
 * Treatment Principles:** Clear the Liver, drain Fire, resolve Phlegm, open orifices, stabilize epilepsy
 * Acupuncture Treatment:** (GB20, GV8, Yao Qi, CV15, LV3, ST40, PC5, GV26, ST6)+ GB20, LI4, CV12, ST36
 * Herbal Treatment:**Long Dan Xie Gan Tang + Di Tan Tang

Obstruction by Wind-Phlegm
//Mild Presentation:// a. stopping activities abruptly; dropping objects suddenly b. forward bending of the neck c. staring upward d. after consciousness returns, patient does not recall incident //2. Severe Presentation:// a. falling down suddenly, sometimes preceded by a scream b. loss of consciousness c. convulsions d. frothing mouth e. after consciousness returns, patient feels fatigue, may have headache, and does not recall incident [Tian Ma (Gastrodia Root) 30g, Chuan Bei Mu (Sichuan Fritillaria) 30g, Fa Ban Xia (Pinellia Tuber) 30g, Fu Ling (Poria) 30g, Fu Shen (Poria Root) 30g, Dan Xing (Arisaema Root) 15g, Shi Chang Pu (Acorus Root) 15g, Quan Xie (Scorpion) 15g, Bai Jiang Can (Silkworm) 15g, Hu Po (Amber) 15g, Deng Xin Cao (Juncus Pith) 15g, Chen Pi (Tangerine Peel) 20g, Yuan Zhi (Polygala Root) 20g, Dan Shen (Salvia Root) 60g, Mai Men Dong (Ophiopogon Tuber) 60g, Gan Cao (Licorice Root) 12g, Zhu Li (Dried Bamboo Sap) 100 ml, Jiang Zhi (Ginger Juice) 50ml]
 * Main Symptoms:**
 * Additional Symptoms:** Dizziness and vertigo, sensation of chest oppression, and sudden weakness may precede loss of consciousness; incontinence
 * Tongue:** White, greasy coating
 * Pulse:** Wiry, slippery
 * Treatment Principles:** Expel Phlegm, extinguish Wind, open orifices, stabilize epilepsy
 * Acupuncture Treatment:** (GB20, GV8, Yao Qi, CV15, LV3, ST40, PC5, GV26, ST6)+ GB20, LI4, CV12, ST36
 * Herbal Treatment:** Ding Xian Wan (Epilepsy-Stabilizing Pill)

Vacuity of Liver & Kidney Yin
[Shu Di Huang (Cooked Rehmannia Root) 24g, Shan Yao (Dioscorea Root) 12g, Shan Zhu Yu (Cornus Fruit) 12g, Gou Qi Zi (Lycium Berry) 12g, Chuan Niu Xi (Cyathula Root) 9g, Tu Si Zi (Cuscata Seed) 12g, Lu Jiao Jiao (Deerhorn Glue) 12g, Gui Ban Jiao (Tortoise Plastron Glue) 12g]
 * Main Symptoms:** chronic epilepsy accompanied by dizziness and vertigo,
 * Additional Symptoms:** Insomnia, poor memory and concentration, weak and achy low back and knees, dry stools, irritability, tinnitus, dry eyes
 * Tongue:** Red, scanty coating
 * Pulse:** Rapid, thready
 * Treatment Principles:** Nourish and supplement Liver and Kidney Yin, subdue Yang, quiet the Spirit
 * Acupuncture Treatment:** (Yao Qi, CV15)+ KI3, LR3, SP6, BL18, BL23
 * Herbal Treatment:** Zuo Gui Wan (Left-Restoring Kidney Yin Pill)

Vacuity of Spleen & Stomach Qi
[Ren Shen (Ginseng) 9g, Bai Zhu (Atractylodes Root) 9g, Fu Ling (Poria) 9g, Jiang Ban Xia (Ginger Processed Pinellia) 6g, Chen Pi (Tangerine Peel) 6g, Zhi Gan Cao (Honey-fried Licorice Root) 6g]
 * Main Symptoms:** chronic epilepsy, fatigue and tiredness, dizziness and vertigo, poor appetite, lusterless complexion, loose stools,
 * Additional Symptoms:** Nausea, vomiting, bloating and distention of chest and epigastrium
 * Tongue:** Pale, greasy coating
 * Pulse:** Soft, weak
 * Treatment Principles:** Strengthen the Spleen, boost Qi, calm the Stomach, transform turbid Phlegm
 * Acupuncture Treatment:** (Yao Qi, CV15)+ BL20, CV12, ST36, ST40, SP6
 * Herbal Treatment:** Liu Jun Zi Tang (Six Gentlemen Decoction)

Tx of Epilepsy with Acupuncture and Moxibustion
//During Seizure// __**Basic Points****:**__ GB20, GV8, Yao Qi, CV15, LV3, ST40, PC5, GV26, ST6
 * Profusion of Phlegm-Fire:** +LR2, GB43, CV12, DU14, GB13
 * Obstruction by Wind-Phlegm:** +GB20, LI4, CV12, ST36

//Interictal Stage//
 * Basic Points:** Yao Qi, CV15
 * Vacuity of Liver & Kidney Yin:** +KI3, LR3, SP6, BL18, BL23
 * If the onset of seizures are at night**: KI 6
 * If the onset of seizures are in the day:** BL 62
 * Vacuity of Spleen Qi with Excess of Phlegm:** +BL20, CV12, ST36, ST40, SP6


 * Ear Acupuncture:** Shen Men, Kidney, Stomach, Heart, Subcortex, Occiput, Brain,

Clinical Tips
Chronic epilepsy patterns are often complicated by Qi stagnation and Blood stasis; therefore, treatments often includes methods to rectify Qi, quicken the Blood, and eliminate stagnation. The addition of medicinal such as Quan Xie and Wu Gong have been found to be effective at extinguishing Wind and relieving spasms, thus increasing the therapeutic effect for all epilepsy patterns. They are generally administered in powdered form that a dose of 1g bid; if administered together the dosage of each is reduced to 0.5g bid. []

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Potential Contributing Factors
Aspartic Acid Excess Asparagine Excess Taurine Deficiency

Contraindicator of
Aspartic Acid Asparagine

=Treatment=

Dietary Recommendations
Food complements: kelp. Take 4-5g. of seaweed at mealtime once a day (powder in capsules or tablets)

Orthomolecular Treatment
-Taurine -Alanine -GABA