Chronic case – 8-year-old child presented with symptoms of muscular dystrophy diagnosed by a medical doctor and seeking alternative treatment.File no is given and the case is recorded and stored for future follow-upsThe case was taken on 23rd august 2013.This child was referred to me by a medical doctor who wanted me to treat the child as there is no definite cure for muscular dystrophy in her system and she wanted me to treat the patient with homeopathy along with her conventional treatment. The patient’s parents provided consent to a medical doctor to discuss a child’s case with me. Prior to agreeing to see the patient, I contacted the medical doctor and discussed the pt’s case and asked her to provide all supporting documents.I provided the patient’s parents information about the nature of the homeopathic treatment, prognosis and treatment plan, and nature and safety of homeopathy medicine and fee structure. An intake form was completed. After a discussion with the patient’s parents, I asked the father to sign a consent form for the treatment, which I placed in the pt’s file. I also explained to the patient’s parents that all the information they provide is confidential and who will have access to it. The possibility of follow-ups visits was also discussed.I asked the parents to answer additional questions to help me to get a better picture of their child’s complaint. I also explained to them that homeopathy is individualized and must be tailored to the child’s individualized symptoms. I asked specific questions to which they provided detailed answers.Before starting the case I observed the child and started greeting her to make her feel comfortable and observed a few objective symptoms.Patient was brought in a wheelchair. She had dark skin with black eyes and black Hair, with rolling head side to side and awkward gate. Pt was unable to walk and walked only with support; she was anxious and was clinging to mother.I proceeded with asking questions to parents saying that I have gone through her case summary and reports but want to know more about your child for a homeopathic approach.Practitioner: What is her chief complaint? Tell me in detail.Patient’s parents: They narrated she had complaints of weakness of all limbs since the age of one year which is slowly progressive in nature. She was not able to walk without support and also lies down with great difficulty and to get up from lying down position is also quite difficult. No history of fall or convulsions, fever, etc. even the patient’s neck muscles are weak so is unable to keep her head straight, her head hold is bad and she keeps striking her head against many things. She was unable to eat, button, wear chappals, and comb the hair. She is handicapped; her muscles over joints are contracted so movements of joints are not possible.They said the patient was also suffering from scoliosis of the spine which causes backache if she sits for some time.She has suffered from cold and cough on and off since childhood with breathlessness and unable to expectorate due to her weak chest muscles. Her complaints are aggravated in the night, lying down, change of weather, damp climate and she is better by sitting and open air.Practitioner: Tell me more about her past and treatment history?Patient’s parents: They said she had Malaria with mixed infection 5 years before and took allopathic medicine. No other significant past and treatment history.Practitioner: Could you narrate about your family history of illness andPatient’s parents: Siblings- 1st, 1 year died. 2nd, 9 month died.3rd, patient. 4th, healthy, living. Parents – healthyPractitioner: Tell me about her personal history in regards to her diet and appetite etc..Patient’s parents: Appetite: Good, Desires/Aversions: craving – spicy3, salt2 Thirst: increased generally for cold water, Perspiration: increased head, face. Stool: 2 / days, Urine: regularPractitioner: Tell me more about her developmental landmarks and problems?Patient’s parents:Birth: Normal, Mother’s Health: Normal during pregnancy, Breastfeeding: 9 months, Physical development: 11 months – sitting, teething – 1½ year, At 2yrs. walks only with support, At 2½yrs.- speaking, Mental development: NormalPractitioner: Tell me more about her physical factors in relation to heat and coldPatient’s parents: She does not like Fan, covers during sleep, have a bath in cold water – habit, chillyPractitioner: Tell me about your child’s emotional and intellectual state?Patient’s parents: Patient is impatient due to her sickness, she is irritable, scolds her parents, and asks for many things. The patient wants to be loved and cared for and wants to become normal like other children.Emotional state: Weepy2, obstinate3, Irritable3, Despair – about her diseaseAffectionate – likes mother very muchReactions: < Contradiction2, < consolationAction (Behavior and functioning including speech) (practitioner’s observation note)Alert, active, speaks wellPractitioner: Tell me about her sleep and dreams?Patient’s parents: she sleeps well and dreams not remembered.( pt answered)OBJECTIVE FINDINGS:Review of systems:I performed a physical examination of the child. Following are the remarks:Appearance: leanHair: Brittle, unhealthyNails: white spots++Face: scar marks+ (forehead)Mouth: caries+Tongue: white-coated, fasciculationTeeth: yellowishPallor+, oedemao, glandso, clubbingo, cyanosisoBP: 120/80 Pulse : 78/minuteR.R: 20/minuteC.V.S ® S1 S2 heard, no murmursR.S ® occassional basal crepts+C.N.S: Higher mental functions – adequateReflexes ® (superficial) - present (weak)(deep) - present (weak)grade power (motor) - undernutrition, Hypotoniasensory ® Normalplantar reflex ® positive (flexor bilaterally)Side note: Anatomical description of muscular dystrophyMuscular Dystrophy is a genetic disorder that is characterized by progressive weakening of the body muscles and it also degenerates the skeletal muscles that control the movements. This condition is inherited and caused by wrong or missing genetic information that prevents the body from making proteins to build and maintain healthy muscles. In muscular dystrophy (MD) the proteins dystrophin and the dystrophin protein complexes are altered. Reference: principles of anatomy and physiology (2006), Tortora, G.J. PP- 319.Patient’s blood reportInvestigations:CPK - 160U/lN - 50% L - 60%M - 02%TC - 5,500/cu mmHb - 9.8gm%ESR - 30mm/hPractitioner’s note: Based on the physical findings and blood picture and also the medical doctor’s diagnosis I confirmed as the patient was suffering from Spinal muscular atrophy - Type II progressive from childhood muscular weakness of all limbs, hypotonicity, muscle wasting, No sensory changes.There is no cure for any form of muscular dystrophy, but medications and therapy can slow the course of the disease along with physical therapy, rehabilitative devices, respiratory care, and surgery which pt is receiving from her family physician so I went ahead in evaluating the patient’s totality of symptoms so that homeopathy can compliment her for long time care.
Muscular Dystrophy Treatment in Homeopathy
Based on symptoms present in the case I constructed chronic and miasmatic totality of the symptom.
Fm – Tubercular to syphilitic
Dm – Tubercular
Recurrent cold and cough
Emaciation, atrophy of muscles
White spots on nails
Remedy: Tub. bov.
The case was also repertorized using radar software to find out the chronic remedy to treat the patient.
Radar license: 16447 – the second method
Sum of degrees (sort:spt) – Full Synthesis
This analysis contains 267 remedies and 16 symptoms. Intensity is considered
• 1.mind – irritability – children, in
• 2.mind – consolation – agg.
• 3.mind – contradiction – intolerant of contradiction
• 4.mind – weeping – children, in
• 5.mind – despair – recovery, of
• 6.mind – affectionate
• 7.generals – weakness – paralytic
• 8. generals – food and drinks – salt – desire
• 9. generals – food and drinks – pungent things – desire
• 10. head – perspiration of scalp
• 11. face – perspiration
• 12. back – curvature of spine
• 13. head – hold – up head, unable to hold
• 14. head – knocks – head against things
• 15. generals – emaciation, marasmus – children; marasmus in
• 16. generals – muscular dystrophy
• REPERTORIAL RESULT: SYNTHESIS
Analysis of Repertorial Result:
Silicea comes in the first place and with the help of other PQRS symptoms the same remedy is confirmed.
Chilly patient, obstinate, delayed development, large head, distended abdomen, and white spots on nails.
Differential remedies considered are Pulsatilla which is an acute of Silicea and it can be prescribed for any acute episodes. Other remedies that came up were Nat Mur and phosphorus.
Nat Mur was a close running medicine but it was ruled out as pt is chilly and she is not extremely irritable and moody like Nat Mur child even though it covers her irritability and contradiction and consolation aggravation and Silicea covers all the pathological symptoms of muscular dystrophy present in this case.
Phosphorus was also thought of but it was ruled out as pt is not that friendly like phosphorus and does not cover all symptoms in the first 3 places after repertorization.
The considered remedies were further researched using boericke’s materia medica 9th edition and radar repertory version 8.2, Encyclopaedia Homeopathica after which Silicea was selected as the Similimum.
I communicated the treatment plan with the pt’s parents and provided them with written instruction. I also recorded it in pt’s file. Silicea 200 c potency was given based on pt’s age and susceptibility, sensitivity, and vitality of the pt, as well as silicea, covers all the symptoms present in physical and emotional level. The administration was one dose orally to allow the medicine to dissolve under the tongue and avoid eating and drinking anything for 30 minutes before and after. I gave only one dose as her vitality was good which was enough to stimulate the vital force. This is supported by aphorism 241-248( organon 6th edition).
Along with this pt was advised to be on a nutritious diet and regular exercise and other interventions needed from medical doctors
I also provided written instructions that homeopathic medicine should be stored away from direct sunlight, heat, and strong odors. I also told pt’s parents to contact me if any symptoms worsened.
1st follow up: 23rd September 2013.
Pt came with no change in any pathological symptom but her general state improved. She is eating well and happy and playing with her siblings and sharing her toys.
My assessment was based on information Silicea was acting. The child is eating well and her mental symptoms are improving as her irritability and stubbornness are reducing in intensity.
I repeated the dose again in higher potency Silicea 1M as I did not find any marked improvement in her pathological level as maybe the dose was lower in potency.
2nd follow up: 25th October 2013
Pt’s parents said she had attack of cold and cough with breathlessness which lasted for a week and went away slowly but her weakness of limbs reduced and she could hold her head for a longer time without banging her head on the wall and she is feeling strong and trying to walk with support after many years and she is less cranky and happy and playful.
• My analysis was based on information that the silicea 1m was acting very well. The appearance of the respiratory symptom may be part of aggravation and was followed by improvement in her pathological symptoms. As Hering’s law of cure states that, “The cure must proceed from centre to circumference. From centre to circumference is from above downward, from within outwards, from more important to less important organs, from the head to the hands and feet.” From this we can analyze pt’s cure is taking place from within outwards.
I felt the action was medicine was progressive and it should be left to act. No prescription.
3rd follow up: 26th November 2013
Pt did not have any aggravation. She is very happy and playful. Her appetite has improved and she has gained some weight and is trying to walk with support. Her will power has improved and she is not worried about her disease any more. In between she had mild cold and cough and wheezing and I felt she needed some anti miasmatic prescription so I gave her Tub bov 200 one dose. Such a prescription, which covers the miasmatic dyscrasia of the person, the chances of recurrence are eradicated and the axiom of ‘rapid, gentle and permanent recovery’ (Hahnemann’s Organon §3) is encompassed.
Pt came once a month for regular follow up and she was prescribed Silicea 200 till 1M for a period of 8 months as the constitutional remedy. For acute episodes of cold and cough puls 200 was given. As miasmatic tub-bov 200 was prescribed infrequently. The patient showed marked improvement at the end of 8 months.