ANYA BALA VIKARA (अन्य बाल विकार – Miscellaneous pediatric disorders)

SEIZURES

Definition

Seizures are defined as abnormal electrical discharge from brain resulting in abnormal involuntary, motor, sensory or autonomic disturbance with or without alteration of sensorium.

Motor - Jerking of limb, twitching of the face.

Sensory - numbness, tingling or burning sensation in a region of the body.

Autonomic - pallor, racing heart rate, nausea.

Psychic - hallucinations (visual, sound, taste or smell), anxiety.

EPILEPSY

Recurrent, episodic, paroxysmal, involuntary clinical events associated with abnormal electrical activity from the brain.

Etiology

1. Early neonatal period :
   1. Birth asphyxia
   2. Hypoglycemia
   3. Intracranial hemorrhage
   4. Inborn error of metabolism
2. Neonatal period :
   1. Hypoglycemia
   2. Kernicterus
   3. Meningitis
   4. Septicemia
   5. Development of malformations
3. From 1 year to 3 years of age
   1. Febrile convulsions
   2. Infections of CNS
   3. Post infectious encephalopathy
   4. SOL : neoplasm, brain abscess
   5. Drugs and poisons

Classifications

Partial : Seizure starts in one area of the brain.

1. Simple Partial

Patient remains alert e.g. jerking of a limb, nausea, strange taste or smell.

There is no loss of awareness or consciousness and they usually last less than a minute.

2. Complex Partial

Altered awareness and behavior e.g confusion, repetitive movements.

After seizure, the person is confused and may not remember anything seizure. Usually last from 30 seconds to 3 minutes.

Generalized

Seizure involves whole brain - consciousness is lost at the onset.

1. Tonic-clonic : 'Grand-mal" or convulsion with loss of consciousness, stiffening of the body then jerking of limbs. Usually lasts approximately two minutes or less.
2. Absence : Petit-mal or staring or trance-like state. Lasts for two to 10 seconds.
3. Atonic : 'Drop attack' or abrupt fall, either with stiffening (tonic) or loss of muscle tone (atonic or astatic attacks).
4. Myoclonic : Sudden muscle jerks usually involving the upper body.

Investigations : EEG, MRI Brain.

Management :

• Emergency Supportive treatment
  • Securing the airway opening
  • Maintaining oxygenation
  • Maintain blood pressure
  • Protect the patient from injury.
• Anti epileptic drugs
  • Carbamazepine - 10-40 mg/kg/day
  • Phenobarbitone - 3-8 mg/kg/day
  • Phenytoin - 3-8 mg/kg/day
  • Valproic acid - 10-60 mg/kg/day
  • Clonazepam - 0.05-0.3 mg/kg/day
  • Clonazepam - 0.1-1 mg/kg/day
  • Ethosuximide - 20 mg/kg/day

APASMARA (अपस्मार)

अपस्मारं पुनः स्मृतिबुद्धिसत्वसंप्लवाद्धिमत्स्चेष्टामावस्थिकं तमः प्रवेशमाचक्षते |

Apasmara is characterized by occasional unconsciousness associated with unreluctant activities like abnormal posture of the body, due to distortion of memory, intellect and other senses.

Nidaana

उद्धान्तविशमबहुदोषाणां (When Doshas get aggravated and their equilibrium is disturbed)

वैषम्ययुक्तेनोपयोगविधिमुपयुज्जानानां (Neglecting the prescribed regimens)

क्षीनदेहनां (Excessive emaciation) ⇒ दोषाः प्रकुपिता (Doshas get aggravated) ⇒ राजस्तमोभ्यामुपाहत (Dosha covered person's whole mind) ⇒ Aggravated doshas fill the heart

इन्द्रियायतनानि ⇒ कामक्रोधलोभमोहहर्षभयशोकचिन्तोद्वेगादिभिर्भुय: (While staying there, doshas aggravated by force of anger etc.) ⇒ सहसाभिपुरयति (All of sudden spread throughout the heart and sense organs) ⇒ तदा जन्तुरपस्मरति ||

Types :

Four types of apasmara

1. Vatika
2. Paittika
3. Shleshmika
4. Sannipatika

Lakshana

Imagining non-existence forms, falls down, Gets tremors, Froathing from the mouth, convulsions, when the convulsions are over, he regains consciousness as getting from the sleep.

Management :

1. संशोधन
2. संशमन
3. पञ्चगव्य घृत
4. महापञ्चगव्य घृत
5. ब्राह्मी घृत
6. वचादि घृत
7. कल्याणक घृत
8. महा कल्याणक घृत
9. नस्य
10. शिरो पिचु
11. वचा चूर्ण with मधु

NIRUDDHAPRAKASHANA (निरुद्धप्रकाशन - Phimosis)

Nidana and Samprapti

वातवर्धक निदान सेवन (Excessive ingestion of nidana responsible for aggravation of vata ) ⇒ चर्म संश्रयते मणिम (Accumulation of vata in foreskin around the penis) ⇒ मणिश्चर्मोपनद्धस्तु (Foreskin covers the penis) ⇒ मुत्रस्रोतोरुणद्धि (Obstruction of urine flow) ⇒ निरुद्धप्रकर्श

Clinical features : Weak urinary stream without pain

Chikitsa :

1. नाडीशस्त्र - स्रोतो विवर्धन (Once in a three days)
2. स्निग्धमन्न भोजयेत
3. शस्त्रकर्म - भेद

PHIMOSIS

Definition

Phimosis is narrowing of prepuital orifice, leading to inability to retract the foreskin over the glans penis.

Etiology

1. Physiological : Normal in newborn male babies. The skin is adhered to the glans and separates over the time.
2. Pathological : It is due to infection either in penis (balanitis) or in the foreskin (posthitis).

Clinical features

1. Physiological : Phimosis involves only non retractability of the foreskin. There may be some ballooning during urination.
2. Pathological :
   1. Skin irritation
   2. Local infection
   3. Dysuria
   4. Pain
   5. Recurrent urinary tract infections.

Classification

• Grade 0 : Full retractability
• Grade 1 : Full retractability but tight behind the penis.
• Grade 2 : Partial exposure of the penis.
• Grade 3 : Partial retraction with meatus just visible
• Grade 4 : Slight retraction neither meatus nor glans visible
• Grade 5 : Absolute no retraction.

Diagnosis : Based on clinical features. No laboratory investigations and imaging studies are required.

Management :

• Management depends upon the etiology either physiological or pathological.
• Depends upon severity of the phimosis, age of the child, type of the non retraction and associated features.
• Surgery.

AKSHEPA (आक्षेप - Convulsions)

• The disease originates from vata kopa in whole body (सर्वाङ्ग संश्रिता वायु) making its स्थान संश्रय especially in धमनि or स्नायु. The vata kopa and its manifestations are cute and intermittent.
• Akshepaka vata vyadhi can be differentiated from apasmaara by features like फेनस्राव, उर्ध्वद्रिष्टि, अपागत स्मृति etc.
• Convulsions in neonates are life theatening and needs immediate and intensive care unit management.

CEREBRAL PALSY

Definition

Cerebral palsy is defined as non progressive disorder resulting from insult to developing brain antenatally, natally or postnatally.

Etiology

Antenatal causes :

1. Intrauterine infections
2. Congenital malformations

Natal cause : Birth Asphyxia (baby not cried soon after birth)

Postnatal causes :

1. Very low birth weight babies (< 1000 gms)
2. Prematurity
3. Kernicterus
4. Neonatal hypoglycemia
5. Postnatal infections - meningitis, septicemia.

Clinical features : Delayed developmental milestones

Associated features :

1. Learning disability
2. Involuntary movements
3. Abnormalities in muscle tone and reflexes
4. Speech disability
5. Hearing impairment
6. Visual impairment, Squint
7. Mental retardation
8. Seizures.

Classification

1. Spastic cerebral palsy
   1. Most common form of CP
   2. Injury to UMN of primary tract
   3. Spasticity, Rigidity and hypertonia of affected parts
2. Dyskinetic CP
   1. Injury of basal ganglia (Kernicterus)
   2. Variable tone of body
   3. Involuntary movements
3. Ataxic CP : Injury of cerebellum

Diagnosis

1. History
2. Physical examination
3. MRI
4. Additional studies :
   1. Test of visual function
   2. Test of hearing
   3. Genetic study (patient with congenital anomalies)

Management

1. Physiotherapy : For prevention of contractures
2. Symptomatic treatment : Ant convulsion drugs for seizures
3. Botulinum inj. in muscles
4. Speech therapy
5. Occupational therapy

Ayurvedic Management of Cerebral Palsy

1. सर्वाङ्ग अभ्यङ्ग (बला तैल)
2. संकर स्वेद in the form of शष्टि शाली पिण्ड स्वेदन
3. मात्र बस्ति (नारायण तैल)
4. नास्य - मर्श or प्रतिमर्श (नारायण तैल/ बला तैल/ ब्राह्मी घृत)
5. शिरो पिचु (नारायण तैल/ बला तैल)
6. बलामूल क्वाथ - 2 times/day
7. वचा चूर्ण with मधु
8. रसायन - ब्रह्म रसायन or च्यवनप्राश
9. योगासन