EPILEPSY (NON-ORGANIC)

EPILEPSY (NON-ORGANIC) 

• In Ayurveda, Apasmara is described as a chronic, episodic neuropsychiatric disorder characterized by bhrama (confusion), moha (loss of consciousness), and bibhatsa cheshta (abnormal movements).

• Non-organic epilepsy refers to psychogenic non-epileptic seizures (PNES) in modern medicine, usually without structural or electrical abnormality in the brain.

ETIOPATHOGENESIS (NIDANA AND SAMPRAPTI)

AYURVEDIC VIEW

NIDANA (ETIOLOGICAL FACTORS):

• Mental trauma, fear, grief, shock

• Suppression of natural urges

• Unwholesome diet and lifestyle

• Alcohol, toxins, or incompatible food combinations

• Genetic tendencies or congenital factors

Sanskrit Reference:

"शोको भयस्य चाप्यन्नं च दु:स्वप्नं विषं मदम्।
अतीन्द्रियार्थसेवा च स्मृतिभ्रंशाय कल्पते॥"
(Charaka Samhita, Nidana Sthana 7/6)

DOSHA INVOLVEMENT:

• Predominant involvement of Vata and Tamas along with Rajo guna

• Association of Pitta or Kapha depending on subtype

SAMPRAPTI (PATHOGENESIS):

• Deranged doshas (especially Vata) vitiate manas and hridaya (mind and heart)

• Obstruction of manovaha srotas

• Affliction of buddhi, smriti, and chetas

• Leads to sudden episodic disturbances in consciousness and behavior

Sanskrit Reference:

"वातादिभिः स्मृतिभ्रंशो हृदयस्पन्दनं च यत्।
विस्मृतं चेतनाभ्रंशस्तेनापस्मार उच्यते॥"
(Charaka Samhita, Nidana Sthana 7/3)

MODERN CORRELATION (PNES / PSYCHOGENIC SEIZURES)

CAUSES:

• Conversion disorder (a psychiatric condition)

• Stress, trauma (e.g., PTSD), abuse history

• Personality disorders, somatoform disorders

• Absence of structural or EEG changes

PATHOGENESIS:

• Emotional conflicts manifest as physical symptoms

• Functional brain networks become disrupted during attacks

• Abnormal activity in frontal-limbic circuitry

CLINICAL FEATURES (LAKSHANA)

AYURVEDIC SYMPTOMS:

• Loss of consciousness (murcha)

• Abnormal body movements

• Frothing from the mouth

• Biting of tongue

• Involuntary urination or defecation

• Post-ictal confusion or fatigue

Sanskrit Reference:

"विबुद्धेऽपि चितं नैव न तद्ब्रूते हि किंचन।
स्मरणं च पुनः प्राप्ते न स्यान्न्याय्यं विचारणम्॥"
(Ashtanga Hridaya, Nidana Sthana 8/10)

MODERN FEATURES (PNES):

• Variable movements, asynchronous limb movements

• Eye closure during attack

• No tongue bite or postictal drowsiness

• Long duration and emotional triggers

• Normal EEG and MRI

TYPES OF APASMARA (ACCORDING TO DOSHA)

• VATAJA: Sudden onset, tremors, anxiety, dry mouth

• PITTAJA: Red eyes, sweating, anger, burning sensation

• KAPHAJA: Heaviness, salivation, dullness, pale face

• SANNIPATAJA: Mixed features, poor prognosis

Sanskrit Reference:

"तीव्रं दारुणलिङ्गं च बहुप्रत्ययकारणम्।
त्रिदोषजनितं घोरं सन्निपातात्मकं स्मृतम्॥"
(Charaka Samhita, Nidana Sthana 7/11)

DIAGNOSIS

AYURVEDIC DIAGNOSIS:

• Based on dosha predominance, clinical features, and nidana

• Observation during attack and postictal state

MODERN DIAGNOSIS:

• Video EEG monitoring – gold standard to differentiate from true epilepsy

• Psychiatric evaluation – for underlying psychological causes

• Rule out metabolic or neurological causes with MRI, CT, blood tests

TREATMENT PRINCIPLES (CHIKITSA SIDDHANTA)

AYURVEDIC MANAGEMENT

SHODHANA THERAPIES:

• Virechana (Purgation): In Pitta and Kapha predominant types

• Basti (Medicated enema): For Vata regulation

• Nasya (Nasal therapy): To clear the head channels

Sanskrit Reference:

"अपस्मारे विशेषेण नस्यं श्रेष्ठं निगद्यते।"
(Ashtanga Hridaya, Uttara Tantra 6/4)

SHAMANA CHIKITSA:

• Medications:

  • Brahmi Ghrita – Medhya, anxiolytic

  • Ashwagandha Churna – Adaptogenic, balances Vata

  • Saraswatarishta – Cognitive enhancer

  • Kalyanak Ghrita – For chronic seizures

  • Unmada Gajakesari Rasa, Smritisagar Rasa

MEDHYA RASAYANA:

• Mandukaparni (Centella asiatica)

• Guduchi (Tinospora cordifolia)

• Shankhapushpi, Yashtimadhu

• Rejuvenate brain function and stabilize mind

SATVAVAJAYA CHIKITSA:

• Counseling, psychological therapy

• Meditation, yoga, spiritual practices

DAIVAVYAPASHRAYA CHIKITSA:

• Use of mantra, homa, japa – to calm mental disturbances

• Faith-based healing along with rational care

MODERN MANAGEMENT OF PNES

PSYCHOTHERAPY:

• Cognitive Behavioral Therapy (CBT) – primary treatment

• Trauma-focused therapy – if past trauma is identified

• Supportive psychotherapy – improve coping mechanisms

PHARMACOLOGICAL THERAPY:

• Antidepressants or anxiolytics if comorbid conditions exist

• Antiepileptics are avoided unless true epilepsy is confirmed

EDUCATION & REHABILITATION:

• Educate patient and family to avoid mislabeling

• Reduce stigma, provide vocational and emotional support

PROGNOSIS (SADHYA-ASADHYA VICHARA)

• Favorable prognosis in early cases with proper counseling

• Poor prognosis in chronic, mixed dosha, or psychiatric comorbidities

• Requires long-term management and regular follow-up