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Line 739: − + + + + + + + + + + + + + + + − Chakrapani comments that ''Agantuka'' i.e. exogenous type of ''apasmara'' is excluded unlike Unmada. Thus Chakrapani rules out the possibility of external factors like Deva, Graha etc. to cause Apasmara and emphasizes the endogenous patho-physiology of Apasmara. Caraka describes the possibility of exogenous factors affecting the individual to suffer from Apasmara in a verse described later. The management of apasmara due to exogenous factors is similar to that described in the management of aagantuja unmada. − Skanda graha and Skandapasmara: − Per Ayurveda, children get afflicted by apasmara due to the effects of any of grahas (Sanskrit, means seizing) such as skandapasmara (due to the effects ofgraha. , ), skanda, etc. knowledge of features of nine evil spirits which seize children is described, Skanda and Skandapasmara are the first two evil spirits which when affect a child, the clinical presentation is similar to that of epilepsy as narrated below. − A child seized by skanda graha has swelling of the eyes, smells like blood, has aversion to the breasts, distorted face, and eyelids or one eye having either loss of movement or more movements. The child could also be restless or irritable, have closed eyes, cry very little, hold its fists tight, and have hard bowel movement. − When the child is seized by skandapasmara, it loses and regains consciousness, is irritable, makes dancing like movements with arms and legs, eliminates stools and passes urine accompanied with sound (crying), yawns more and emits froth from the mouth. These are the features of a child seized by the “friend of skanda graham”, i.e., skandapasmara. − Similar to this, Vagbhata in Ashtanga Hridayam, has described the variants of the disease caused due to demons/evil spirits possessing the children. The cardinal signs of graha possession (or affliction) include continuous fever and crying. The general features are fear, too much yawning, movement of eyebrows, timidity, discharge of froth from mouth, upward gaze, biting of lips and teeth (grinding), wakefulness (absence of sleep), crying, moaning, aversion for the breast, change of voice, and scratching its own body or that of the mother by nails without any reason. − In conventional medicine, epilepsy in children is described in detail. However, the etiology of some variants of epilepsy is mentioned to be idiopathic. As described in context of skanda and skandapasmara, the involvement of supernatural powers in causing apasmara is a matter of debate and falls in the purview of theology. Considering its importance and prevalence, apasmara of unknown etiology can be categorized as of the fifth type i.e. aagantu apasmara. Sushruta and his commentator Dallhana support this view that any variant of the disease which occurs without any reason, acutely and without any rational pathology shall be considered as aagantu. Per Charaka [Chikitsa 10/53], the etiopathology, clinical features and management of this fifth type are on the lines of aagantu unmada. As commented by Chakrapani, in case of aagantu or bhutapasmara, the etiology of being seized by some external factors is considered primary and the involvement (anubabdha) of dosha as secondary. It is important to note here that since clinical patho-physiology cannot take place without the involvement of doshas, therefore aagantu should technically be considered as one of the four doshic variants of apasmara mentioned earlier, in order to follow the sankhya niyama i.e. rules of numeral classification.
→Agantu Apasmara
There are four types of ''apasmara'' depending upon the predominance of ''dosha'' as shown in fig. 5. The first thing of significance is that all these are ''sharira doshas'' and not ''manasa doshas''. This implies that apasmara is predominantly a somatic disease in which psychological factors play a role in pathogenesis. The important aspect of management should be focused at the somatic level supported by psychotherapy. The role of genetic constitution is important in the study of clinical manifestations of ''apasmara'' as well as their response either to treatments involving allopathic anti-epileptic medications or to Ayurvedic treatment modalities. The diagnosis of dominance of ''dosha'' is also important in deciding the treatment modalities prescribed in cases of ''apasmara''. The epigenetic variation of the four types of ''apasmara'' and the categorization of etio-pathological factors to lead the epigenetic modification resulting into specific type of ''apasmara'' is worthy of study.
There are four types of ''apasmara'' depending upon the predominance of ''dosha'' as shown in fig. 5. The first thing of significance is that all these are ''sharira doshas'' and not ''manasa doshas''. This implies that apasmara is predominantly a somatic disease in which psychological factors play a role in pathogenesis. The important aspect of management should be focused at the somatic level supported by psychotherapy. The role of genetic constitution is important in the study of clinical manifestations of ''apasmara'' as well as their response either to treatments involving allopathic anti-epileptic medications or to Ayurvedic treatment modalities. The diagnosis of dominance of ''dosha'' is also important in deciding the treatment modalities prescribed in cases of ''apasmara''. The epigenetic variation of the four types of ''apasmara'' and the categorization of etio-pathological factors to lead the epigenetic modification resulting into specific type of ''apasmara'' is worthy of study.
===== Agantu Apasmara =====
===== ''Agantu Apasmara'' =====
Chakrapani comments that ''Agantuka'' i.e. exogenous type of ''apasmara'' is excluded unlike ''unmada''. Thus Chakrapani rules out the possibility of external factors like ''deva, graha'' etc. to cause ''apasmara'' and emphasizes the endogenous patho-physiology of ''apasmara''. Charaka describes the possibility of exogenous factors affecting the individual to suffer from ''apasmara'' in a verse described later. The management of ''apasmara'' due to exogenous factors is similar to that described in the management of ''agantuja unmada''.
===== ''Skanda graha'' and ''Skandapasmara'' =====
Per [https://en.wikipedia.org/wiki/Ayurveda Ayurveda], children get afflicted by ''apasmara'' due to the effects of any of ''grahas'' (Sanskrit, means seizing) such as ''skandapasmara'' (due to the effects of ''graha''.), ''skanda'', etc. knowledge of features of nine evil spirits which seize children is described, ''skanda'' and ''skandapasmara'' are the first two evil spirits which when affect a child, the clinical presentation is similar to that of epilepsy as narrated below.
A child seized by ''skanda graha'' has swelling of the eyes, smells like blood, has aversion to the breasts, distorted face, and eyelids or one eye having either loss of movement or more movements. The child could also be restless or irritable, have closed eyes, cry very little, hold its fists tight, and have hard bowel movement.
When the child is seized by ''skandapasmara'', it loses and regains consciousness, is irritable, makes dancing like movements with arms and legs, eliminates stools and passes urine accompanied with sound (crying), yawns more and emits froth from the mouth. These are the features of a child seized by the “friend of skanda graham”, i.e., ''skandapasmara''.
Similar to this, Vagbhata in Ashtanga Hridayam, has described the variants of the disease caused due to demons/evil spirits possessing the children. The cardinal signs of ''graha'' possession (or affliction) include continuous fever and crying. The general features are fear, too much yawning, movement of eyebrows, timidity, discharge of froth from mouth, upward gaze, biting of lips and teeth (grinding), wakefulness (absence of sleep), crying, moaning, aversion for the breast, change of voice, and scratching its own body or that of the mother by nails without any reason.
In conventional medicine, epilepsy in children is described in detail. However, the etiology of some variants of epilepsy is mentioned to be idiopathic. As described in context of ''skanda'' and ''skandapasmara'', the involvement of supernatural powers in causing ''apasmara'' is a matter of debate and falls in the purview of theology. Considering its importance and prevalence, ''apasmara'' of unknown etiology can be categorized as of the fifth type i.e. ''agantu apasmara''. Sushruta and his commentator Dallhana support this view that any variant of the disease which occurs without any reason, acutely and without any rational pathology shall be considered as ''agantu''. Per Charaka [Chikitsa 10/53], the etiopathology, clinical features and management of this fifth type are on the lines of ''agantu unmada''. As commented by Chakrapani, in case of ''agantu'' or ''bhutapasmara'', the etiology of being seized by some external factors is considered primary and the involvement (''anubabdha'') of ''dosha'' as secondary. It is important to note here that since clinical patho-physiology cannot take place without the involvement of ''doshas'', therefore ''agantu'' should technically be considered as one of the four doshic variants of ''apasmara'' mentioned earlier, in order to follow the ''sankhya niyam''a i.e. rules of numeral classification.
Premonitory signs of apasmara:
Premonitory signs of apasmara:
The table 1 depicts the premonitory signs of apasmara described in the Ayurvedic texts. Each sign has a specific patho-physiology in terms of dosha and dushya behind its manifestation. The enlisted signs are the alerting signals or premonitory symptoms of apasmara before the onset of seizures. The probable system involved as per conventional medicine is also enlisted for every sign, so that it would be easier to consider the pathophysiological similarities and differences between the two medical streams.
The table 1 depicts the premonitory signs of apasmara described in the Ayurvedic texts. Each sign has a specific patho-physiology in terms of dosha and dushya behind its manifestation. The enlisted signs are the alerting signals or premonitory symptoms of apasmara before the onset of seizures. The probable system involved as per conventional medicine is also enlisted for every sign, so that it would be easier to consider the pathophysiological similarities and differences between the two medical streams.