A Rare Entity Trigeminal Neuralgia V3 Treated With Algorithmic Treatment Vamana, Virechana, Basti and Nasya - A Case Report

Transcription

1 A Rare Entity Trigeminal Neuralgia V3 Treated With Algorithmic Treatment Vamana, Virechana, Basti and Nasya - A Case Report

2 BASELINE A 60 year old female case was reported to Kayachikitsa department in Jan 2011 with the complaints of episodic most horrible, shocking and burning pain in lower jaw beginning from implanted tooth at the time of talking and taking food.

3 BASELINE Subjective parameters of assessment Episodic most horrible shocking and burning pain in lower jaw. Heaviness in lower jaw. Pain triggered at the time of talking and taking food. Objective parameters of assessment. MRI was showing vascular adhesion to trigeminal nerve.

4 BASELINE. Investigations conducted by Neurologist and results MRI was showing vascular adhesion to trigeminal nerve. Other general investigations and clinical evaluations are within normal limits. Implant surgeon, neurologist and neurosurgeon treated this case for thirteen months but case was not responding. Hence neurosurgeon advised surgery.

5 Description of Patient Name of Patient- Vimal Ramdas Jaybhaye Age-62 yrs Gender-F Nationality-Indian State-Maharashtra District-Parbhani Appearance - First-class Physical and mental disposition standard Occupation House wife Socio-economic status higher Mob

6 Complaints Presenting Complaints as perceived by the patient Doctor I am suffering from episodic horrible, shocking and burning pain in lower jaw beginning from implanted tooth at the time of talking and taking food and I am not able to take food as well as afraid of food intake.

7 Findings Subjective parameters of assessment Episodic Severe shocking and burning pain in lower jaw. Heaviness in lower jaw. Pain triggered at the time of talking and taking food. Objective parameters of assessment MRI was showing vascular adhesion to trigeminal nerve.

8 Histories Relevant personal and family history- Tooth implant on date Oct No other relevant personal and family history to this disease.

9 Diagnosis Allopathy Diagnosis Patient is already diagnosed as trigeminal neuralgia V3 by Implant surgeon, neurologist and neurosurgeon treated this case for thirteen months but case was not responding. Hence neurosurgeon advised surgery.

10 Diagnosis. Ayurveda view of diagnosis Patients diagnosis was considered as tridoshaja disease of anantvata category.

11 Treatment Plan Patient convinced for algorithmic treatment vamana, virechana, basti and nasya.

12 Treatment Plan-purvakarma Langhana For initial 3 days Snehapana with Mahanaraya na taila Krishara 100 ml daily for 7 days with leukwarm water at 8 am Yavagu of shastik shali mixed with dadimrasa Yavagu of shastik shali after hunger sensation

13 Treatment Plan- Vamana karma After complete snehapana Abhyanga with Mahanarayana tailam at 9am and at 4pm twice for one day with Dashmula kwath nadi Shali mixed with sugar and milk diet before a day of vamana. Madanaphala 20gm+Madhu 20gm + Sharkara 20gm=Mantha Mungadal yusha 1 lit. Early morning 7am.

14 Treatment Plan-samsarjana krama Day Lunch Dinner 1 st 2 nd 3 rd 4 th 5 th -- Peya Vilepi Krita yavagu Krita yavagu Peya Vilepi Akrita Yavagu Akrita Yavagu Normal diet.

15 Observations at the midpoints Subjective parameters of assessment As per patients assessment episodic pain, burning and heaviness was reduced upto 5% only and negligible. Pain triggered at the time of talking and taking food was same as before. Objective parameters of assessment. MRI report was not advised.

16 Treatment Plan-purvakarma Snehapana with Mahanaraya na taila 100 ml daily for 7 days with leukwarm water at 8 am Yavagu of shastik shali after hunger sensation

17 Treatment Plan- Virechana karma After complete snehapana Abhyanga with Mahanarayana Taila at 9am and at 4pm twice for 03 days and Dasmula kwath baspa Krishara Trivrittavaleha 100gm at 9.30 am.

18 Treatment Plan-samsarjana krama Day Lunch Dinner 1 st 2 nd 3 rd 4 th 5 th -- Peya Vilepi Krita yavagu Krita yavagu Peya Vilepi Akrita Yavagu Akrita Yavagu Normal diet.

19 Observations at the midpoints Subjective parameters of assessment As per patients assessment pain and heaviness was reduced upto 10% only and burning was reduced up to 25%. Pain Triggered at the time of talking and taking food was same as before. Objective parameters of assessment. MRI report was not advised.

20 Treatment Plan-purvakarma Snehapana with Mahanaraya na taila 100 ml daily for 05 days with lukewarm water at 8 am Yavagu of shastik shali after hunger sensation

21 Treatment Plan- Basti karma After complete snehapana Abhyanga with Mahanarayana Taila at 4pm and Dasmula kwath baspa sweda. Krishara Yoga Basti Mahanarayana taila Matrabasti 60 ml and Dashmuladi niruha basti

22 Treatment Plan-samsarjana krama Day Lunch Dinner 1 st 2 nd 3 rd Peya Vilepi Krita yavagu Vilepi Akrita Yavagu Normal diet.

23 Observations at the midpoints Subjective parameters of assessment As per patients assessment pain and heaviness was reduced upto 40% only and burning was reduced up to 50%. Pain triggered at the time of talking and taking food was reduced to 30% only. Objective parameters of assessment. MRI report was not advised.

24 Treatment Plan- Nasya karma Abhyanga with Mahanarayana Taila at 4pm and Dasmula kwath baspa sweda. Krishara Pratimarsha Nasya with Anu taila For seven Days

25 Treatment Plan-shamana Mahanarayan a oil 30 ml early morning with luke warm water regularly Ashvagandha ghrita 30 ml before dinner with luke warm water regularly

26 Progress of the treatment After treatment, frequency of episodes was reduced up to 50% only. As per patients assessment pain and heaviness was reduced upto 40% and burning was reduced up to 50% only. Pain triggered at the time of talking and taking food was reduced to 30% only. Patient is asked to reduce the allopathic medicine doses tid to bid to od and stopped. Patient was able to take lukewarm liquid diet.

27 Progress of the treatment Oral shamana treatment was advised along with anu taila pratimarsha nasya. After six months same panchakarma procedures were performed and patient relieved 90% in her complaints. Same panchakarma treatment was repeated after one year and patient relived completely. Shamana treatment was discontinued except pratimarsha nasya. Virechana and basti karma was repeated after one year to prevent the recurrance.

28 Outcomes at Endpoint Patients complaints were completely relived after regular treatment as per schedule. Recurrance is not observed up to June Patient was not ready for MRI hence objective parameter is aviated.

29 BT AT Comparison BT Episodic Severe shocking and burning pain in lower jaw. Heaviness in lower jaw. Pain triggered at the time of talking and taking food. AT No episodic Severe shocking and burning pain in lower jaw. No heaviness in lower jaw. No pain triggered at the time of talking and taking food.

30 Conclusions Algorithmic management vamana, virechana, basti and nasya is showing positive effects in most horrible case Trigeminal neuralgia V3 Long term treatment plan along with regular follow-up is required to improve such irremediable disease. Recurrence is very common in this disease hence long term treatment and follow up is required. Patient is not receiving any Allopath medications for this disease. Hence treatment efficacy is not suspicious.

31 Acknowledgements I am thankful to Sow Vimal Jaybhaye, highly cooperative, sincere and obedient patient. I am highly thankful to Charutar Vidya Mandal for providing such complete hospital along with keen administration of Principal and Kayachikitsa and Panchakarma Departmental staff.

32 References Pandit Kashinath shastri,pandit Gangadhar Pandeya,editors.Charaka samhita (part II) with Ayurved Dipika Commentary of Chakrapani datta & with Vidyotini Hindi commentary, Chaukhambha Sanskrit Sansthan, Delhi, edition 2006, chikitsa sthana Tatli M, Satici O, Kanpolat Y, Sindou M. Various surgical modalities for trigeminal neuralgia: literature study of respective long-term outcomes. Acta Neurochir (Wien) 2008; 150(3): [PubMed]

33 Thank you