AYURVEDIC APPROACH TO CLINICAL MANAGEMENT OF EPILEPSY (APASMARA)

1. 4th International Conference on
Ayurveda, Unani, Siddha & Traditional Medicine 2016
“Indigenous Knowledge for Health Challenges”
08th – 10th December 2016
organized by
Institute of Indigenous Medicine
University of Colombo
Rajagiriya, Sri Lanka
1

2. AYURVEDIC APPROACH TO CLINICAL
MANAGEMENT OF EPILEPSY
(APASMARA)
 PRESENTOR: Dr PRABHAKAR MANU, PG SCHOLAR
 GUIDED BY : Dr SUHAS KUMAR SHETTY & Dr SAVITHA H P
DEPARTMENT OF MANO VIJYAN EVAM MANASA ROGA
SDM COLLEGE OF AYURVEDA & HOSPITAL
HASSAN-573201,
KARNATAKA, INDIA 2

3. CONTENTS
 INTRODUCTION TO EPILEPSY (APASMARA)
 CAUSATIVE FACTORS
 IMPORTANT FEATURES OF EPILEPSY (APASMARA)
 CLINICAL APPROACH
 VEGA KALINA APPROACH
 VEGANTARA KALINA APPROACH
 UNDERSTANDING THE SAMPRAPTI
 DISCUSSION
 CONCLUSION 3

4. OVERVIEW OF EPILEPSY (APASMARA)
 Chronic neurological disorder characterized by
episodic unprovoked seizures
 Causes: brain injury, stroke, brain tumour,
infections of the brain, and birth defects.
 Approx. 50 million people worldwide have epilepsy
- WHO.
 स्मृतेरपगमं प्राहुरपस्मारं भिषग्विदः|
तमःप्रिेशं बीित्सचेष्टं धीसत्त्िसम्प्लिात्|| Cha. Chi. 10/3 4

5. तमःप्रिेशं
Pre-ictal phase
बीित्सचेष्टं
Ictal phase
धीसत्त्िसम्प्लि
Post-ictal phase
Loss of consciousness
(entering into darkness)
Convulsions with
Teeth biting
Altered state of
consciousness
Aura,
Deviation of the eyes
Dribbling of
Frothy saliva
Drowsiness
Salivation and
Nasal discharge
Expiratory dyspnoea Confusion
Sensation of spasm Involuntary speech or
murmuring
Nausea
Congestion of heart Head retraction
To one side
Headache
Giddiness Constriction of the
fingers, unstable
movements of the limbs
Epilepsy ‘Apasmara’

6. MANAGEMENT THROUGH AYURVEDA ?????
• Consumption of AED
• Adverse effects
• Chances of relapse
• Shodhana and Shamana
treatment
• Decreased frequency of
attack
• Less chances of relapse
and less side effects
6
MODERN MEDICINE AYURVEDA

7. CAUSATIVE FACTORS
AHARA- DIET VIHARA- LIFESTYLE MANASIKA-
PSYCHOLOGICAL
Heavy for digestion(guru
ahara)
Suppression of thirst and
appetite (vega-
kshutvega dharana)
Persistent grief, passion
and anger, Mental
irritation(chinta)
Incompatible food
(viruddhahara)
Excess work
(ativyayama)
Timid personality
Alcohol (madya),
Nicotine
Unethical activities
(abhichara)
Insult of teachers and
elders (guru-
vriddhapachara)
Fish (matsya) Impaired Sleep wake
cycle
Intellectual blasphemy
Tiredness (shrama)
Prajnaparaadh
7

8. APASMARA
SANNIPATAJ
PITTAJ
KAPHAJ
VAATAJ
8

9. ASSESSMENT
DIAGNOSIS
TREATMENT
9

10. FEATURES VAATAJ PITTAJ KAPHAJ SANNIPATAJ
FROTH AND
COLORS
Vomiting froth
Yellowness of
the foam, limbs,
face and eyes
White colour of
the foam from
the mouth,
body, face and
eyes
Pain in the
heart, thirst and
nausea
AURA
Gets visual aura
of forms which are
rough, pink or
black in color
Aura of yellow
or blood- red
objects
Visualizes the
whole world as
if set in flames
Aura of white
objects
MIXED AURA
OTHER
FEATURES
Rigorous
breathing
Gnashing of teeth
Trembling
Morbid thirst
and heat
Horripilation
Feeling of
heaviness and
cold
Delirious talk
and the making
of indistinct and
moaning
sounds
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11. FEATURES VAATAJ PITTAJ KAPHAJ SANNIPATAJ
Bibhatsa Chesta +++ ++ + +++
Tama Pravesha +++ ++ ++ +++
Dhee Satva Samplava + + ++ +++
Inter-Ictal phase + ++ +++ +++
Ictal phase + ++ +++ +++
Horripilation - - +++ +++
Trishna and Daha - +++ - +++
Gnashing of Teeth +++ - - +++
11

12. 12
SAMPRAPTI
S
T
H
A
Y
I
V
E
G
A
K
A
L
I
N
A
SANCHAYA
VYAKTHA BHEDA
STHANA SAMSRAYA
PRASARA
PRAKOPA
SANCHAYA
PRAKOPA
PRASARA
STHANA SAMSRAYA
VYAKTHA BHEDA
UPAHATA CHETAS
UTPADAKA NIDANA
HRIDAYA & INDRIYAYATANA
APASMARA ROGA
VYANJAKA HETU
OCCLUSION OF SANJNAVAHA SROTAS
DHI SATVA SAMPLAVA
SMRITI APAGAMA
APASMARA VEGA

13. 13

14. 14
VEGA KALINA
SANJNA
PRABODHANA
VEGANTARA
KALINA
PREVENTING
FURTHER
EPISODES
APASMARA
TREATMENT

15. TREATMENT -BEFORE SEIZURES - 1*
 ON EXPERIENCING AURA, HALLUCINATIONS-
 Get away from water, fire, height, sharp objects, climbing
trees, riding vehicles
 Move towards flat large space area
 Inform someone nearby if possible
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16. DURING SEIZURES - 2*
 Prevent injuries by placing the patient on flat surface
 Head in lateral position to prevent obstruction in breathing
 Placing mouth gag if possible so as to avoid tongue and
cheek bite
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17. JUST AFTER SEIZURE - 3*
 Nasya – Pippalyadi nasya, Tulasi swarasa,
Lashuna swarasa, Vacha choorna,
Jyotishmati taila
 Dhuma – Pippalyadi dhuma, Palankashadi
 Anjana – Marichadi, Manashiladi, Shirisadi
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18. VEGANTARA KALINA CHIKITSA
 REMOVAL OF ETIOLOGICAL FACTORS
 PRAVARA SNEHAPANA (KETOGENIC DIET)
 Basti (Medicated Enema)– Vataja
 Virechana (Classical Purgation)– Pittaja
 Vamana(Classical emesis) - Kaphaj
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19. SNEHAPANA - HIGH INTAKE
 Brahmi Ghrita-
 Polyherbal formulation ( Bacopa monneri, Evolvulus
alsinoids, Acorus calamus, Saussurea lappa and Cow’s
ghee) – Motor Coordination, Behaviour, Sleep, Convulsions,
Locomotion and analgesia was evaluated in mice using
standard procedures and results showed that Brahmi
Ghrita protected mice from maximum electroshock and
pentylenetetrazole induced convulsion.
 -Achliya GS, Wadodkar SG, Dorle AK. Evaluation of CNS activity of
Brahmi Ghrita. Indian J Pharmacol 2005;37:33-6.
http://dx.doi.org/10.4103/0253-7613.13853
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20. SNEHAPANA – CONT….
 Panchagavya Ghrita-
 Panchagavya ghrita as Arohana Matra Sneha
followed by Virechana provided significant and
better relief in most of the symptoms of epilepsy.
 Chitrangana CN et al/ Int. J. Res. Ayurveda Pharm. 5(6), Nov-Dec
2014
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21. TANTU PASHAN
Sanskrit Name
Botanical
Name
Quantity
Maricha
Piper nigrum
berry
180 mg
Chavya
Piper chabab
stem
80 mg
Tantu Pashan
Bhasma*
Magnesium
Silicate
140 mg
Sudhakar Pemminati et al. / Journal of Pharmacy Research 2010,
3(5),1178-1180
On chronic administration, the test
drug significantly reduced the
duration of tonic hind limb
extension and also the clonus
phase in MES induced seizures.
But, in PTZ induced seizures,
neither it reduced the duration of
clonic convulsion nor protected the
animals from death. Results
indicates that Tantu Pashan has
protective effect against MES, but
not against PTZ induced seizures.

22. SHAMANA MEDICINES
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 Brahmi ghrita
 Panchagavya Ghrita
 Kalyanaka Ghrita
 Vachadi ghrita
 Mahachaitasa ghrita
 Ashvagandarista
 Kooshmandaka ghrita
 Saraswatarishta
 Smritisagara rasa
 Brahma rasayana etc.

23. DO’S AND DON’TS
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AHARA VIHARA MANASIKA
Old rice (purana shali) Rest(vishrama) Avoiding excessive Stress
60 days rice (shashtika
shali)
Cold water bath (sheetala
jala snana)
Family support
Wheat (godhuma) Soothening music
(manohita karani)
Positive reinforcement
Green gram soup (mudga
yusha)
Coping skills for social
interaction
Drum stick (shigru) and
Grapes(draksha)
Cow’s milk (goksheera),
Cow’s ghee(goghrita)
Fig(phalgu)
Pomegranate(dadima)
Gooseberry(amalaki)

24. SINGLE DRUGS
 Vacha- Acorus calamus Linn.
 Shankhapushpi-Convolvulus
pluricaulis Chosis.
 Kooshmanda- Ash gourd–Benincasa
hispida (Thunb.)Cogn.
 Jyotishmati- Celastrus paniculata Linn.
 Yastimadhu- Glycyrrhiza glabra Linn.
 Jatamamsi- Nardostachys jatamansi Dc.
 Tagara- Valeriana jatamansi Jones.
 Lashuna-Garlic- Allium sativa Linn.
 Amalaki-Gooseberry- Emblica
officinalis Gaertn.
 Rasna- Pluchea lanceolata C. B. Clarke.
 Hingu-Asafetida- Ferula narthex Boiss.
 Choraka- Angelica glauca Edgew.
 Kushta- Saussurea costus (Fale.) Lipsch.
 Phalgu-Fig- Ficus carica Linn.
 Brahmi- Bacopa monnieri (Linn.) Pennell.
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25. PRANAYAMA OR DEEP DIAPHRAGMATIC BREATHING
 In this method, as a person slips into a seizure state and is
trained to reflexively catch and hold their breath as if
startled or frightened. This causes changes in metabolism,
blood flow, and oxygen levels in the blood.
 The practice of pranayama, i.e., controlled deep
diaphragmatic breathing, helps restore normal respiration;
this can reduce the chances of going into a seizure or stop
the seizure before it becomes full blown.
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26. DISCUSSION
o Modern antiepileptic drugs suppress the seizure, but do
not cure the disorder from root. The main drawbacks are
adverse effects , contraindications and sometimes lifetime
treatment.
o Ayurveda believes in balancing humours (dosha) to
remove the root causes of the disorders and normalize the
brain activity.
o In the context of apasmara, The main aim of treatment is to
pacify the doshas and to clear the occlusion of sanjna vaha
srothas.
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27. DISCUSSION
 Ketogenic diet (Ghrita) is a safe and effective
treatment for intractable epilepsies; it has been
recommended since 1921. The diet induces ketosis,
which may control seizures.
 Ayurveda includes shamana, tikshna sanshodhan,
rasayan chikitsa, sattvavajaya chikitsa.
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28. CONCLUSION
 Apasmara is a neuropsychiatric disease & has
episodic manifestation.
 Etiopathogenesis should be properly understood to
diagnose & manage the cases of apasmara.
 Apasmara has sthayi & vega kalina samprapti.
 Management of apasmara is divided into vega
kalina & vegantara kalina chikitsa.
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29.  Duration of the treatment should be planned
according to chronicity, severity etc. of the
disease & response to the treatment.
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