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Line 634: − + − In conventional medicine, three major factors that cause disturbance in cerebral neurotransmission leading to blackouts and epilepsy viz. hypo-perfusion, hypo-metabolism, and hypoxia have been described in relevant medical texts. These disturbances lead to abnormal discharges, improper signal transduction in the neurotransmitter channels, and seizures. As a consequence, cellular dysfunctions in the brain, disruptions of the memory mechanism, and disturbed coordination of movements may occur causing the clinical manifestation of apasmara. The role of these three factors and its impact on memory and cellular dysfunction in the pathogenesis of epilepsy need to be elucidated. The three pathological effects are comparable to the changes created by vitiation of kapha, pitta and vata. Differentiation between these three types of manifestations is described further. − Per Ayurveda, smriti is atmaja (originated from the soul) and sattvaja (originated from the mind). This means that smriti (memory) of a person is essentially related with soul and mind. The Bhagavad Gita describes the consequences of excessive indulgence in sensory activities leading to excessive affliction resulting in an increase in passion, then anger, and then lack of knowledge. This further leads to deterioration of smriti and then affecting the intellect. This sequence lays the ground for apasmara. − 3: Tattva sara: + − + + + + + + + + + + + + + + + + + + − Predisposing factors for apasmara: − The susceptible individuals and conditions for epilepsy are described in detail. − 1. Rajas –tamas affliction: − The first factor, rajas - tamas affliction, signifies the role of mind in etio-pathology of apasmara. Rajas is a guna (tendency or attribute) responsible for the initiation of every kind of activity and symbolizes energy, while Tamas is the guna symbolizing inertia, dulling or stopping of activities. These two play an important role in the coordination of activities within the sequence of sense organs-mind-intellect-spirit, in the attainment of knowledge as well as to maintain the orientation of external world (consciousness). A rajas-tamas affliction, therefore, adversely impacts coordination of activities and perverts the mind and intellect, landing the patient into loss of orientation and consciousness. A “distressed” state of mind, caused by rajas-tamas affliction, is an important etiological factor responsible for various psychosomatic disorders such as epilepsy. Therefore, rehabilitating the rajas - tamas balance (and thus, achieving harmony between all the three gunas) is of utmost importance in preventing the pathology and maintenance of health. Neurologically, initiation of action through neurotransmitters such as acetylcholine, while inhibition of action through dopamine can be categorized under rajas and tamas respectively. Synchronization of discharges in the cerebral region is a result of rajas -tamas balance. Disturbance in this rajas-tamas balance and depletion of sattva leads to hypersynchronization, resulting in seizures. Threshold of neuronal activity is due to balance between sattva, rajas and tamas, It is sattva that maintains the normal threshold of neuronal activities. Decreased sattva and/or increased rajas and tamas can alter the threshold of neurons. − The state of mind afflicted due to rajas and tamas can be considered as ‘distressed mind’ observed as important causative factor for various psycho somatic disorders like epilepsy. − 2. Sharira dosha vitiation:
→Impairment of knowledge and co-ordination
Fig. 2: Faculty involved in attainment of knowledge
Fig. 2: Faculty involved in attainment of knowledge
According to Ayurveda, knowledge of external objects is processed through sense organs , to the mind- intellect, culminating in the spirit. This chain or sequence for attainment of knowledge is important for proper functioning of memory (encoding, storage and retrieval) and intellect (cognition) [Fig.2]. Occasional impairment of coordination in the sequence consisting of sense organs-intellect-mind-spirit is seen in apasmara. This may lead to decrease in cognitive performance of an individual.
According to [https://en.wikipedia.org/wiki/Ayurveda Ayurveda], knowledge of external objects is processed through sense organs , to the mind- intellect, culminating in the spirit. This chain or sequence for attainment of knowledge is important for proper functioning of memory (encoding, storage and retrieval) and intellect (cognition) [Fig.2]. Occasional impairment of coordination in the sequence consisting of sense organs-intellect-mind-spirit is seen in apasmara. This may lead to decrease in cognitive performance of an individual.
In conventional medicine, three major factors that cause disturbance in cerebral neurotransmission leading to blackouts and epilepsy viz. hypo-perfusion, hypo-metabolism, and hypoxia have been described in relevant medical texts. These disturbances lead to abnormal discharges, improper signal transduction in the neurotransmitter channels, and seizures. As a consequence, cellular dysfunctions in the brain, disruptions of the memory mechanism, and disturbed coordination of movements may occur causing the clinical manifestation of ''apasmara''. The role of these three factors and its impact on memory and cellular dysfunction in the pathogenesis of epilepsy need to be elucidated. The three pathological effects are comparable to the changes created by vitiation of ''kapha, pitta'' and ''vata''. Differentiation between these three types of manifestations is described further.
Three factors of mind, memory, intellect and consciousness are impaired in apasmara. Due care should be taken to protect and manage these three. Herbs like medhya rasayana and treatment modalities like sattvajaya chikitsa are known to promote activities of mind, intellect and consciousness.
Per [https://en.wikipedia.org/wiki/Ayurveda Ayurveda], ''smriti'' is ''atmaja'' (originated from the soul) and ''sattvaja'' (originated from the mind). This means that ''smriti'' (memory) of a person is essentially related with soul and mind. The Bhagavad Gita describes the consequences of excessive indulgence in sensory activities leading to excessive affliction resulting in an increase in passion, then anger, and then lack of knowledge. This further leads to deterioration of ''smriti'' and then affecting the intellect. This sequence lays the ground for ''apasmara''.
==== ''Tattva Sara'' ====
Three factors of mind, memory, intellect and consciousness are impaired in ''apasmara''. Due care should be taken to protect and manage these three. Herbs like ''medhya rasayana'' and treatment modalities like ''sattvajaya chikitsa'' are known to promote activities of mind, intellect and consciousness.
==== Predisposing factors for ''apasmara'' ====
The susceptible individuals and conditions for epilepsy are described in detail:
===== ''Rajas–tamas'' affliction =====
The first factor, ''rajas - tamas'' affliction, signifies the role of mind in etio-pathology of ''apasmara''. ''Rajas'' is a ''guna'' (tendency or attribute) responsible for the initiation of every kind of activity and symbolizes energy, while ''Tamas'' is the ''guna'' symbolizing inertia, dulling or stopping of activities. These two play an important role in the coordination of activities within the sequence of sense organs-mind-intellect-spirit, in the attainment of knowledge as well as to maintain the orientation of external world (consciousness). A ''rajas-tamas'' affliction, therefore, adversely impacts coordination of activities and perverts the mind and intellect, landing the patient into loss of orientation and consciousness. A “distressed” state of mind, caused by ''rajas-tamas'' affliction, is an important etiological factor responsible for various psychosomatic disorders such as epilepsy. Therefore, rehabilitating the ''rajas - tamas'' balance (and thus, achieving harmony between all the three ''gunas'') is of utmost importance in preventing the pathology and maintenance of health. Neurologically, initiation of action through neurotransmitters such as acetylcholine, while inhibition of action through dopamine can be categorized under ''rajas'' and ''tamas'' respectively. Synchronization of discharges in the cerebral region is a result of ''rajas-tamas'' balance. Disturbance in this ''rajas-tamas'' balance and depletion of ''sattva'' leads to hypersynchronization, resulting in seizures. Threshold of neuronal activity is due to balance between ''sattva, rajas'' and ''tamas''. It is ''sattva'' that maintains the normal threshold of neuronal activities. Decreased ''sattva'' and/or increased ''rajas'' and ''tamas'' can alter the threshold of neurons.
The state of mind afflicted due to ''rajas'' and ''tamas'' can be considered as ‘distressed mind’ observed as important causative factor for various psycho somatic disorders like epilepsy.
===== ''Sharira dosha'' vitiation =====
The second important factor is imbalance of doshas at the somatic level. There are three terms used to indicate the state of doshas which predisposes apasmara. First is udbhranta (moving upwards in vitiated state). The upward direction of flow of doshas may indicate the pathway of apasmara from the heart to the brain. The pathology starts from the abode of consciousness i.e. heart, spreading upwards afflicting sense organs. In Chikitsasthana, the term vibhranta is used to denote this condition. The second state is vishama, meaning a state of disequilibrium. Imbalanced doshas create a favorable environment for apasmara. The third state is bahu (excessive), meaning that the imbalance is excessive enough to affect the brain-mind system. This suggests that the doshas are in an aggravated state of imbalance and predispose to the disease. The condition also points towards manifestation of apasmara as a result of other somatic disease pathologies. The disease condition is a result of combination of the above states of doshas with the rajas-tamas affliction. These are sanchaya (accumulation), prakopa (aggravation) and prasara (spread) stages of the disease - important somatic factors for causation of apasmara.
The second important factor is imbalance of doshas at the somatic level. There are three terms used to indicate the state of doshas which predisposes apasmara. First is udbhranta (moving upwards in vitiated state). The upward direction of flow of doshas may indicate the pathway of apasmara from the heart to the brain. The pathology starts from the abode of consciousness i.e. heart, spreading upwards afflicting sense organs. In Chikitsasthana, the term vibhranta is used to denote this condition. The second state is vishama, meaning a state of disequilibrium. Imbalanced doshas create a favorable environment for apasmara. The third state is bahu (excessive), meaning that the imbalance is excessive enough to affect the brain-mind system. This suggests that the doshas are in an aggravated state of imbalance and predispose to the disease. The condition also points towards manifestation of apasmara as a result of other somatic disease pathologies. The disease condition is a result of combination of the above states of doshas with the rajas-tamas affliction. These are sanchaya (accumulation), prakopa (aggravation) and prasara (spread) stages of the disease - important somatic factors for causation of apasmara.
The cumulative presentation suggests the psychosomatic nature of the disease where the psyche and soma are equally involved in the pathogenesis. This is important while treating apasmara, because this indicates that only administering anti-epileptic drugs is not enough in treating apasmara. The treatment of underlying psychological factors shall also be given due emphasis.
The cumulative presentation suggests the psychosomatic nature of the disease where the psyche and soma are equally involved in the pathogenesis. This is important while treating apasmara, because this indicates that only administering anti-epileptic drugs is not enough in treating apasmara. The treatment of underlying psychological factors shall also be given due emphasis.