Changes

=== Prognosis of apasmara ===

=== Prognosis of apasmara ===

Epilepsy due to vitiation of all the three doshas and showing all clinical features of the ''sannipatika'' variant (i.e., of all the other three ''doshic'' variants) is chronic in nature and that, which has occurred in a person with excess degenerative condition and depleted ''dhatus'', is considered incurable. In case of degenerative conditions and chronic diseases, any case of apasmara due to vitiation of even a single ''dosha'' can be considered incurable.  

Epilepsy due to vitiation of all the three [[dosha]]s and showing all clinical features of the ''sannipatika'' variant (i.e., of all the other three ''doshic'' variants) is chronic in nature and that, which has occurred in a person with excess degenerative condition and depleted ''[[dhatu]]s'', is considered incurable. In case of degenerative conditions and chronic diseases, any case of apasmara due to vitiation of even a single ''[[dosha]]'' can be considered incurable.  

   

   

Bad prognostic signs of apasmara patients can often turn fatal. If one, in his wakeful state sees darkness where there is no darkness and hears all types of sound even when there is no sound, he succumbs to apasmara. If a patient, while dancing in an intoxicated state is caught by a ''preta'' (soul of a dead person) with his head facing downwards, he is sure to succumb to an attack of apasmara.  

Bad prognostic signs of apasmara patients can often turn fatal. If one, in his wakeful state sees darkness where there is no darkness and hears all types of sound even when there is no sound, he succumbs to apasmara. If a patient, while dancing in an intoxicated state is caught by a ''preta'' (soul of a dead person) with his head facing downwards, he is sure to succumb to an attack of apasmara.

=== Reasons behind aggressive and dormant stages of apasmara ===

=== Reasons behind aggressive and dormant stages of apasmara ===

   

   

From the above sections, it is clear that apasmara occurs in episodes. The patient after seizure regains consciousness like waking up from sleep (''suptavat pratibuddhyate''). Therefore, there are two stages of disease : one is aggressive stage of ''doshas'' and the second is dormant stage of ''doshas''. Sushruta describes that there are two forms of pathogenesis: One form follows the six stages viz. ''sanchaya'' etc.(''kramopayogad'') of the disease in sequence and takes considerable time to manifest disease with gradual onset. The other form manifests acutely in a short time (''kshanikatwat''). The first form is seen in ''nija'' (endogenous) pathologies of disease. The other form is seen in ''agantu'' (exogenous) apasmara. Sushruta gives examples of a seed in the ground that sprouts only during ''sharad ritu'' (autumn) though it rains at other times. Analogous to this example, the virulent form of the disease develops due to a ''dosha'' getting aggravated in very short time and manifesting its different symptoms due to some factors catalyzing the accelerated aggravation. It is quite clear from the detailed descriptions in this chapter, though, that all forms of apasmara are caused by ''dosha'' only. [Su.Sa.Uttara Tantra 61/1821]

From the above sections, it is clear that apasmara occurs in episodes. The patient after seizure regains consciousness like waking up from sleep (''suptavat pratibuddhyate''). Therefore, there are two stages of disease : one is aggressive stage of ''[[dosha]]s'' and the second is dormant stage of ''[[dosha]]s''. Sushruta describes that there are two forms of pathogenesis: One form follows the six stages viz. ''sanchaya'' etc.(''kramopayogad'') of the disease in sequence and takes considerable time to manifest disease with gradual onset. The other form manifests acutely in a short time (''kshanikatwat''). The first form is seen in ''nija'' (endogenous) pathologies of disease. The other form is seen in ''agantu'' (exogenous) apasmara. Sushruta gives examples of a seed in the ground that sprouts only during ''sharad ritu'' (autumn) though it rains at other times. Analogous to this example, the virulent form of the disease develops due to a ''[[dosha]]'' getting aggravated in very short time and manifesting its different symptoms due to some factors catalyzing the accelerated aggravation. It is quite clear from the detailed descriptions in this chapter, though, that all forms of apasmara are caused by ''[[dosha]]'' only. [Su.Sa.Uttara Tantra 61/1821]

   

   

The example states the fact that favorable environment for precipitating factors plays major role in disease episodes. Depending upon the defense system of the body – its natural and acquired immunity -  as the background for disease and factors aggravating the ''dosha'' as offending agents, the interaction between the two defines severity, intensity and frequency of occurrence of episodes of disease as shown in chart. [ Fig.4: Manifestation of episodes ]

The example states the fact that favorable environment for precipitating factors plays major role in disease episodes. Depending upon the defense system of the body – its natural and acquired immunity -  as the background for disease and factors aggravating the ''[[dosha]]'' as offending agents, the interaction between the two defines severity, intensity and frequency of occurrence of episodes of disease as shown in chart. [ Fig.4: Manifestation of episodes ]

[[File:mainfastation.png|500px|'''Fig.4: Manifestation of episodes'''|thumb]]<br>  

[[File:mainfastation.png|500px|'''Fig.4: Manifestation of episodes'''|thumb]]<br>  

Therefore, for prevention and management of a disease, it is important either to build up the strength of defense system i.e. improving the ''sharira bala'' (physical strength) and ''sattva bala'' (mental strength), or pacify/weaken the aggravating causative factors or both.

Therefore, for prevention and management of a disease, it is important either to build up the strength of defense system i.e. improving the ''sharira bala'' (physical strength) and ''sattva bala'' (mental strength), or pacify/weaken the aggravating causative factors or both.

=== Management of apasmara ===

=== Management of apasmara ===

Although the management of apasmara is described further in [[Chikitsa Sthana]], principles of management are given in this chapter. The curable types of epilepsy should be carefully treated with strong elimination and alleviation therapies according to the vitiated dosha. ''Doshas'' present in the vessels above the heart need to be removed which require strong measures requiring medicines having higher penetrability, higher potency and highest bio-availability. With this objective, ''tikshna samshodhana'' (strong elimination) and ''samshamana'' (alleviation therapies) are employed. When extrinsic causative factors are involved (''agantu apasmara''), then ''mantras'' etc., will be useful.

Although the management of apasmara is described further in [[Chikitsa Sthana]], principles of management are given in this chapter. The curable types of epilepsy should be carefully treated with strong elimination and alleviation therapies according to the vitiated [[dosha]]. ''[[Dosha]]s'' present in the vessels above the heart need to be removed which require strong measures requiring medicines having higher penetrability, higher potency and highest bio-availability. With this objective, ''tikshna samshodhana'' (strong elimination) and ''samshamana'' (alleviation therapies) are employed. When extrinsic causative factors are involved (''agantu apasmara''), then ''mantras'' etc., will be useful.

 

The rationale behind advocating strong elimination therapies is the deeper location and excess vitiated state of ''[[dosha]]s''. As described in patho-physiology earlier the ''[[dosha]]'' are in dormant state in the vessels above heart. Therefore to remove these ''[[dosha]]'', strong eliminatory therapies are needed. The strength of the prescribed medicine is decided by their higher penetrability, potency and bio-availability.

=== Practical application of principles ===

=== Practical application of principles ===

#Clinical correlation with modern radiological investigations like CT etc. and EEG for better clinical diagnosis of apasmara  

#Clinical correlation with modern radiological investigations like CT etc. and EEG for better clinical diagnosis of apasmara  

#Enlisting newly introduced disease commonly observed in society into the umbrella of apasmara e.g. Alzheimer’s dementia, depression etc.  

#Enlisting newly introduced disease commonly observed in society into the umbrella of apasmara e.g. Alzheimer’s dementia, depression etc.  

#Retrospective analyses of all signs and symptoms enlisted in the modern text books and formulating probable ''samprapti'' / pathophysiology (''dosha-dushya sammurchchna'') based on ''dosha'' dominance behind manifestation of each sign and symptom can be formulated for better understanding in Ayurvedic perspective.  

#Retrospective analyses of all signs and symptoms enlisted in the modern text books and formulating probable ''samprapti'' / pathophysiology (''dosha-dushya sammurchchna'') based on ''[[dosha]]'' dominance behind manifestation of each sign and symptom can be formulated for better understanding in Ayurvedic perspective.  

#Assessment criteria in [[Ayurveda]] and modern science, modern investigation methods and technologies, biomarkers which are well established may be enlisted.

#Assessment criteria in [[Ayurveda]] and modern science, modern investigation methods and technologies, biomarkers which are well established may be enlisted.

* [[Apasmara Chikitsa]]

* [[Apasmara Chikitsa]]

==References==

==References==