Abstract

CASE STUDY ABSTRACT FOR ORAL PRESENTATION

 

This case has been selected for oral submission as it is a long followed up case of a rare disease which is Autoimmune in nature and the exact etiology is not yet fully known. This disease according to standard literature is prevailing @ of one case per million per month, occurring year round. It is a disorder of the peripheral nerves outside the brain and spinal cord. The acute manifestations frequently include severe and fulminant polyradiculoneuropathy.

 

THE CLINICO-PATHOLOGY AND MANIFESTATIONS

 

Research to date indicates that nerves of the G.B.S patient are attacked by the body’s own defense system against disease – anti bodies and white blood cells. G.B.S. destroys the protective covering of the peripheral nerves (myelin sheath) disabling the nerves from transmitting signals to the muscles. If the myelin sheath does’nt recover the nerve itself.

 

As a result of this autoimmune attack. The nerve insulation (myelin) & some times even the covered conducting part of the nerve (axon) is damaged.

 

                                 

 

Rapidly evolving areflexia, motor paralysis, with or without sensory disturbances.

 

 

Preceding/ predisposing conditions. About 75% of G.B.S. cases are preceded by 1 to 3 weeks of acute infectious process mostly of the respiratory system or gastro intestinal system. Many a times preceded by infections of Human Herpres Virus, Epstein Barr Virus, Cytomegalo Virus, Mycoplasma Pneumonia in some cases. It is also noted that Older types of Rabies Vaccine prepared in nervous system tissue have triggered G.B.S.

 

Usual pattern is ascending paralysis, may be first noticed as Rubbery Legs. The weakness typically evolves over hour to a few days and frequently accompanied by tingling disesthesias in the extremities. The legs are more affected than arms.

 

Facial diparesis is present in 50% of affected individuals.The Lower Cranial Nerves are also frequently involved. There if Bulbar weakness with difficulty in handling secrections and maintaining an airway.

 

Most patients require hospitalization because of the Autonomic involvement and about 30% require ventilatory assistance at some time during the illness. This case is a well diagnosed from a Govt. Hospital and duly supported by EMG-NCV study during her admission period between 10.08.2004 to 03.09.2004.

 

THE EMG-NCV Study dated 21.08.2004

Conclusion

 

1.         Severe generalized motor polyradiculoneuropathy in all four limbs { post tibial, peroneal, femoral, median, axillary and peripheral nerves }. Late Response {F & H} are absent.

2.         Absent sensory responses in both sural and sensory axonopathy in both median nerves.

3.         Nonspecific EMG findings due to profound muscle weakness. No signs of active denervation are noted.

*          These findings agree with clinical diagnosis of severe  GBS {type AIDP, mostly motor involvement in all four limbs }.

 

It is after her discharge in a completely paralyzed, disabled state, Homoeopathic consultation was sought for, after remaining at home without any treatment and recovery for about 3 months upto 05.12.2004.

 

This is one of the few cases where the patient was not available for interrogation in person, as she was staying away from our city. The only source of information was her husband who was reporting about her condition periodically and the hospital record. The life space investigations of the patient where also elicited through her husband.

 

 

Summarizing the entire situation, the main theme which emerged in the life space

 

investigation of the patient was DISCONTENT.

Other personality traits and causations considered.

 

  • Parochialism
  • Purely interested in personal and domestic affairs.
  • Timidity
  • Stubborn and Obstinate.
  • Uncomplicated person.
  • H/O innumerable aches and pains symbolizing conflicts between perceived demands and doubts about meeting them.
  • Sudden decrease of energy at a specific movement, from a shock.
  • A blockage created by the defense mechanism in the conduit connecting the mental and emotional “organs” of the body.

 

I Settled on Calcarea Phosphorica in Fifty Millesimal Scale.

The Follow Up-

 

 

 

 

 

Although this disease cannot be put in the category of somatoform disorder the homoeopathic approach have cured the case totally within a span of about 9 months (Dec’04 to Oct’05) she is under observation for past 6 years and living a normal life. She is absolutely from the most frustrating consequence of this disorder  viz, fatigue, exhaustion, abnormal sensations including pain and muscle aches, numbness, etc.

 

The posology selected was Fifty Millesimal Potency for frequent repetitions till amelioration ensued, which was discontinued later.

 

Limitations- It is needless to say that, all cases of G.B.S.shall not respond to Homoeopathic treatment, but the survivors of this disease can certainly be benefited by minimizing the consequences and help them a post episode symptom free life.  

 

References-    1) Harrison’s Principles of Internal medicine (16th Edition).

 

                        2) Essence of Materia Medica by George Vithoulkas.