Changes

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 ''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.  

 

While considering the clinical pictures of a disease, the attributes of doshas responsible for variation in pathologies at somatic and psychological level should be emphasized. Important mechanisms of loss of consciousness and abnormal movements at the somatic level, and impairment of intelligence and memory at psycho-pathological levels needs to be focused. The epigenetic patterns related to particular signs and symptoms originated from doshic pathologies can be researched to reveal new treatment methods and management aspects. The genetic constitution of a person plays a significant role in making him prone to developing certain type of disorders. Therefore, as discussed above for vata apasmara can become more apparent after taking vata-aggravating diet and lifestyle in vata prakriti individuals that can get alleviated by using vata shamana (i.e., vata-pacifying) diet and lifestyle. Furthermore, if anti-epileptic drugs are used more judiciously depending upon the dosha and prakriti-specific diagnosis, then the treatment regimen can be made much more precise leading to beneficial results in patients. As discussed in the section of predisposing factors, the preventive lifestyle and dietary regimens can be designed to prevent incidence of epilepsy, reduce the dose of drugs with supportive diet and lifestyle therapy and prevent further progression of disease. Therefore, training of epileptics regarding causative and avoidable factors is of utmost importance. The epigenetic variations in epileptics due to enlisted causative agents should be studied as a part of genomic and proteomic research.

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.  

 

While considering the clinical pictures of a disease, the attributes of ''doshas'' responsible for variation in pathologies at somatic and psychological level should be emphasized. Important mechanisms of loss of consciousness and abnormal movements at the somatic level, and impairment of intelligence and memory at psycho-pathological levels needs to be focused. The epigenetic patterns related to particular signs and symptoms originated from ''doshic'' pathologies can be researched to reveal new treatment methods and management aspects. The genetic constitution of a person plays a significant role in making him prone to developing certain type of disorders. Therefore, as discussed above for ''vata apasmara'' can become more apparent after taking ''vata''-aggravating diet and lifestyle in ''vata prakriti'' individuals that can get alleviated by using ''vata shamana'' (i.e., ''vata''-pacifying) diet and lifestyle. Furthermore, if anti-epileptic drugs are used more judiciously depending upon the ''dosha'' and ''prakriti''-specific diagnosis, then the treatment regimen can be made much more precise leading to beneficial results in patients. As discussed in the section of predisposing factors, the preventive lifestyle and dietary regimens can be designed to prevent incidence of epilepsy, reduce the dose of drugs with supportive diet and lifestyle therapy and prevent further progression of disease. Therefore, training of epileptics regarding causative and avoidable factors is of utmost importance. The epigenetic variations in epileptics due to enlisted causative agents should be studied as a part of genomic and proteomic research.

Differential diagnosis of apasmara:

Differential diagnosis of apasmara:

Other disorders such as mada (intoxication) and murchcha (syncope) also show the signs of loss of consciousness, but ones without convulsions. In unmada, there is impairment of buddhi, and it does not manifest itself with loss of consciousness. Akshepa (abnormal movements) is a vata-predominant disease characterized with convulsions, but the consciousness is intact and there is no froth discharge. This makes apasmara a distinct disease apart from other disorders.  

Other disorders such as mada (intoxication) and murchcha (syncope) also show the signs of loss of consciousness, but ones without convulsions. In unmada, there is impairment of buddhi, and it does not manifest itself with loss of consciousness. Akshepa (abnormal movements) is a vata-predominant disease characterized with convulsions, but the consciousness is intact and there is no froth discharge. This makes apasmara a distinct disease apart from other disorders.