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→Premonitory signs of apasmara
majja
majja
The abovementioned pre-clinical features are observed in the fourth stage of shatkriyakala (pathogenesis). These may be considered as aura in apasmara patients. These are important in view of prevention of apasmara progression to epileptic seizure. In conventional medicine text books, some of the above signs like auditory and visual hallucinations are referred. These signs need to be searched upon for their prevalence, categorization as per dosha dominance, involvement of dosha attributes in order to establish precise guidelines for early prevention and management of disease.
The abovementioned pre-clinical features are observed in the fourth stage of ''shatkriyakala'' (pathogenesis). These may be considered as aura in ''apasmara'' patients. These are important in view of prevention of ''apasmara'' progression to epileptic seizure. In conventional medicine text books, some of the above signs like auditory and visual hallucinations are referred. These signs need to be searched upon for their prevalence, categorization as per ''dosha'' dominance, involvement of ''dosha'' attributes in order to establish precise guidelines for early prevention and management of disease.
Table 2: Differentiation between types of apasmara
Table 2: Differentiation between types of apasmara
Su: As described by Sushruta in Sushruta Samhita AH: As described in Ashtang Hridaya
Su: As described by Sushruta in Sushruta Samhita AH: As described in Ashtang Hridaya
The specific features of all the four types of apasmara are described in Table 2. Vata type of apasmara manifests itself with repeated seizures of short duration and increased frequency of attacks. The speed, severity and abnormality of movements are more in this case. This is due to chala (movable), laghu (light), and sukshma (minute) attributes of vata dosha. Vata is the initiator of all activities including those of the body and the mind. The regulation and coordination of the sequence of sense and locomotor organs – mind-intellect-soul for attainment of knowledge is performed by vata. Prana vata, udana vata and vyana vata are involved in the pathophysiology of apasmara. The clinical manifestation of vataja apasmara may be due to repeated, excess, hyposynchronous discharges in neurons of the central nervous system. Transient hypoxia leading to dysregulation of brain functioning, and neurological diseases similar to epilepsy syndromes can be categorized under this type of apasmara.
The specific features of all the four types of ''apasmara'' are described in Table 2. ''Vata'' type of ''apasmara'' manifests itself with repeated seizures of short duration and increased frequency of attacks. The speed, severity and abnormality of movements are more in this case. This is due to ''chala'' (movable), ''laghu'' (light), and ''sukshma'' (minute) attributes of ''vata dosha''. ''Vata'' is the initiator of all activities including those of the body and the mind. The regulation and coordination of the sequence of sense and locomotor organs – mind-intellect-soul for attainment of knowledge is performed by ''vata''. ''Prana vata, udana vata'' and ''vyana vata'' are involved in the pathophysiology of ''apasmara''. The clinical manifestation of ''vataja'' ''apasmara'' may be due to repeated, excess, hyposynchronous discharges in neurons of the central nervous system. Transient hypoxia leading to dysregulation of brain functioning, and neurological diseases similar to epilepsy syndromes can be categorized under this type of ''apasmara''.
In ''pitta apasmara'', the frequency, duration of paroxysms will be comparatively less than those observed in ''vata'' type. The ''ushna'' (hot) and ''tikshna'' (acrid) attributes of ''pitta'' are responsible for the pathology of paroxysms. ''Sadhaka pitta'' located at the heart and the functions responsible for accomplishment of activities are responsible for this ''apasmara''. ''Tamahpravesha'' is a sign primarily of ''pitta''-dominance in which metabolism or transformation at the cellular level might be an underlying pathology. Derangement of ''sadhaka pitta'' implies the decrement or depletion in psychological performance in ''apasmara'' patients. Since ''pitta'' is responsible for all metabolic activities, the derangement of metabolism at the cellular level is an important pathological factor and the enzymatic pathways might be held responsible. The types of epileptic syndromes originating due to metabolic disorders like hepatic encephalopathy can be categorized under this type. Changes in body temperature, excess thirst, and perspiration are specific differentiating features of pitta apasmara. The cerebral conditions due to derangement of metabolisms can be enlisted here.
In cases of kaphaja apasmara, the sthira (stable), manda (slow), and snigdha (unctuous) attributes of kapha are responsible for delayed onset, prolonged duration as well as minimal frequency of paroxysms in apasmara. Excessive sleep and hypothermia specifically suggest kaphaja apasmara. Hypoperfusion and hypovolemic conditions leading to cerebral dysfunction can be considered as attributes of kaphaja apasmara.
In cases of kaphaja apasmara, the sthira (stable), manda (slow), and snigdha (unctuous) attributes of kapha are responsible for delayed onset, prolonged duration as well as minimal frequency of paroxysms in apasmara. Excessive sleep and hypothermia specifically suggest kaphaja apasmara. Hypoperfusion and hypovolemic conditions leading to cerebral dysfunction can be considered as attributes of kaphaja apasmara.
Finally, the sannipatika type of apasmara presents itself with complex mixed features due to overlapping of all doshas. The prognosis is poor leading to incurability of disease. This might be a mixed presentation of neuronal, endocrinal, circulatory and metabolic pathways.
Finally, the sannipatika type of apasmara presents itself with complex mixed features due to overlapping of all doshas. The prognosis is poor leading to incurability of disease. This might be a mixed presentation of neuronal, endocrinal, circulatory and metabolic pathways.