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MND Ay Perspective
MND Ay Perspective
Ayurvedic prospective’
Dr.P.K.Sudarsan.Nair, M.D.
Director Research
VAIDYARATNAM AYURVEDA FOUNDATION
THRISSUR,KERALA
Motor Neuron Disease,
A Review.
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Motor neuron disease
Motor neuron diseases are a group of
neurodegenerative disorders that affects the nerves in
the spine and brain to progressively lose its function.
They are a rare but serious and incurable form of
progressive neurodegeneration.
It is a condition that selectively affects the motor
system, the cells which control voluntary muscles of the
body.
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Definition
It is defined as a progressive disease that
involves degeneration of the motor neurons
and wasting of the muscles.
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INCIDENCE
Motor neuron disease (MND) occur in
adults and children.
It can appear at any age, but most patients
are over 40 years old at diagnosis.
It affects men more than women.
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Classification
Three types of MND are recognized but the
distinction is somewhat artificial since most
patients eventually develop features of all the
three:
Progressive muscular atrophy
Amyotrophic lateral sclerosis
Bulbar involvement - either:
o Spastic: pseudobulbar palsy
o Flaccid: bulbar palsy
Mixed: progressive bulbar palsy
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Etiology-Cause is not clearly known
Syndromes resembling MND may occur:
following chronic poisoning with
aluminium,mercury, lead, manganese, or selenium
in association with disorders of metabolism -
hypoglycemia, uremia, macroglobulinaemia,
and following gastric surgery
following trauma to a limb,electric shock,slow irus
infection
in association with other progressive degenerative
diseases of the nervous system of unknown aetiology -
Pick's disease, parkinsonism, Creutzfeldt-Jakob
disease
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Clinical Features
Presentation of motor neuron disease depends on the
particular pathways involved:
combined upper and lower motor neuron features are
present in 65% of cases
bulbar features are present in 25%
muscle weakness and atrophy are present in 10%
Features usually develop gradually.
The initial complaint is often non-specific,
e.g. a weakening hand grip.
hand - wasting, weakness, fasciculation
Characteristic complaints:
bulbar involvement - dysarthria and dysphagia
lower limb - weakness with spasticity
difficulty in breathing
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Characteristic negative features:
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Patterns of involvement of MND
Progressive muscular atrophy
Predominantly spinal motor neurons affected
Weakness and wasting of distal limb muscles at first
Fasciculation in muscles
Tendon reflexes may be absent
Contd...
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Progressive bulbar palsy
Early involvement of tongue palate and pharyngeal muscles
Dysarthria/dysphagia
Wasting and fasciculation of tongue
Maybe pyramidal signs as well
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Pathogenesis
As nerve cells die when pt have a motor neuron disease,
electrical messages can't get from the brain to muscles.
Over time, muscles waste away, known as “atrophy.”
When this happens, it leads to lose control over
movements. It gets harder to walk, talk, swallow, and
breathe.
Each kind of motor neuron disease affects different types
of nerve cells or has a different cause. ALS is the most
common of these diseases in adults.
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Early stage signs and symptoms:
a weakening grip, making it hard to pick up and
hold things
Fatigue, difficulty swallowing
muscle pains, cramps, and twitches
slurred and sometimes garbled speech
weakness in the arms and legs
increased clumsiness and stumbling
trouble breathing or shortness of breath
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Middle stage signs and symptoms:
As the condition progresses, symptoms become more
severe.
Muscle pain and weakness increase, and spasms and
twinges worsen.
Limbs become progressively weaker.
Limb muscles start to shrink.
Movement in affected limbs becomes more difficult.
Limb muscles may become abnormally stiff.
Joint pain grows.
Eating, drinking, and swallowing become harder.
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Drooling occurs, due to problems controlling saliva.
Yawning occurs, sometimes in uncontrollable bouts
Jaw pain may result from excessive yawning.
Speech problems worsen, as muscles in the throat and
mouth become weaker.
The person may show changes in personality and
emotional state,with bouts of uncontrollable crying or
laughing.
Secondary symptoms include insomnia, anxiety, and
depression.
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Advanced stage signs and symptoms
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Differential Diagnosis
Other diseases which lead to muscular wasting,
especially of the upper limbs, must be considered:
syringomyelia - fasciculation are rare; dissociated
sensory loss loss usually prominent from an early
age
intramedullary tumor - sensory
cervical spondylosis - sensory loss is usually
present but the upper limb weakness and lower
limb spasticity may be remarkably similar to MND.
MND has a more rapid myelopathy and cervical
disc protrusion will be absent on X-ray.
Occasionally, MND may co-exist with cervical
spondylosis.
contd….
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Contd
cervical rib - fasciculation absent, pain prominent,
sensory loss usually present, characteristic radiology
peripheral nerve lesions - localized wasting,
usually accompanied by sensory loss.
peroneal muscular atrophy - sensory loss
chronic poliomyelitis - differentiate by
electromyography and muscle biopsy
myasthenia gravis - bulbar signs but rarely
muscular wasting; responds rapidly to
anticholinesterase
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Prognosis
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Motor Neuron Disease,
Ayurvedic Perspective
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Any reference of equivalent disease to
MND in Ayurveda?
What would be the etiological factors of
this disease?
What are the samprapthy ghatakas?
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“Ekam sasthramadheeyano na
vidyatsasthra nischayam
Thasmat bahusrutham sasthram
vijaneeyat chikitsaka”.
(Susrutha samhitha)
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Basic concept of disease
“Rogasthu dosha vaishamyam” (Ash. Hru)
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In the conclusions arrived at by the Scientific
Memoranda of sub committee (Poona 1947) of the
Chopra committee on indigenous system of medicine
(1946-48) presented in the form of a “Charter of
agreements” It has been stated that Vayu acts through
the nervous system (central, peripheral and
autonomic).
(Chopra Committee-Vol II Page 191)
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Disease,Ayurvedic Perspective
A disease is a combination of
symptoms produced by the interaction
of morbid Doshas with Dhatus and
Malas in specific sites.
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“Nasthi rogo vina doshai yasmathasmad vichakshana
(Sushrutha samhitha)
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“Adrushta desa kaladi parinamadanekadha
Puranapravileyanthe naveena pradurasathe
Vibhidyathe sthithaschadha
nrunam nanavidhagada:”
(Sidhantha Nidana)
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Symptoms and Nature of dosha dushti
Symptoms Conditions
Balakshaya ----- Vatavridhi-- udana vaikalya
Karmakshaya ---- Vyana&Udana
Sphurana ----- Vatavridhi
Mamsasosha - --- Vatavridhi
Vakvikruthi ---- Udana & Vyana
contd….
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contd
Aniyanthritha
hasa rudadi-- Vatavridhi –(Prana&vyana)
Sthambha---- Vatavridhi in sira and snayu,
Lalasrava -- Kapha vridhi
Bhaktharodha---- vata vaigunya
Prana & Udana
Swasa --- Prana & Udana
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Qualities/Exciting factors of vata
Rukshatwa, Ruksha
laghutwa, laghu
sitatwa, sita
chalatwa, Daruana
kharatwa, Khara
visadatwa,and
sukshmatwa.
(ca.su.1:57)
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Vata vruddhi lakshana
Sarira karsya--- Indriya kshaya---loss of
emaciation*
sensory activity
Karshnya--dark
pigmentation Ashti sula---pain in bone
Gatra kampa---tremor Malasanga--constipation
Sphurana---twitching Adhmana/atopa-
sensation*
distension of abdomen
Ushnakamitha---longing
for hot items Mohalasya---dizziness
Samja nasa---loss of Dainyatha---sickness
conciousness
Bhaya/soka-fear/sadness
Nidrahani---insomnia
Balakshaya---weakness*
Pralapa---delirium
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Outcome of Vatakopa
1.Dhatukshaya- Depletion of
body tissues.
2. Margavarodha- Obstruction in the
conducting channels.
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Probable Aetiological factors
a) Environmental factors-
Desa– Jangala
Kala-- Greeshma,varsha
b)Food habits- ushna, thiktha kashaya resa, rukshahara
Insufficient/excessive intake of food
In combatable food items
free radical production)
c)Occupational factors-
(midhya vihara)- exposure to toxins, excito toxicity
–
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contd
d)Physiological- trauma ,injury,old age
e) Psychological- fear, sorrow, anxiety,
f )Familial.- kulaja
g)Pranjaparadha-
h)Itrogenic – improper administration of
sodhana therapy
i) Immunologic-
(ojakshaya) - slow virus infection
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•Dhatukshaya—Depletion of tissues
•Vegadharana—Suppression of natural urges
•Ativyayama— Excessive exercise
•Rukshahara— Dry food items
•Atikshudha— Severe hunger for want of food
•Abhikhata— Trauma,injury
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Samprapthy ghataka
Amaya— Sarvanga vatha
Udbhava sthana--Hrudaya –Masthiska
Sanchara – Nadi-
Adhishtana-- Asthi, majja,mamsa
Srothus-- Resavaha,Mamsavaha,
Cheshtavaha
Vyapthi-- Sarvanga
Dosh dushti-- Vatavrudhi-Prana,vyana,udana
Kapha Kshaya
Dushya-- Resa, Mamsa,majja,Asthi
Vyadhi - Utharothara vrudhi
swabhava— (Progressive)
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Samprapthy NIDANA
Doshadushti
Margavarodha Vathaprakopa
Srothodushti
Dhatukshaya
Vyana vykalya
Prana+Udana Vykalya
Balakshaya-vakvikruthi- Karmakshaya-Sphurana-
Bakthrodha,Swasa Sthambhana
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Vikruthi pareeksha
Doshas
Samanyja ---Nanatmaja Nanatmaja
Prakruth/ vaikrutha}
(Dosha/Kalam)— } Vatha/Vrudha
Anubandhya dosha Vatha
Anubandha dosha------- Kapha
Prakruthy/ Vikruthy- Anupakrama,Yapya
Sama / - Nirama - - Nirama
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Vikruthi Pareeksha
Gathi- Thiryak
Parinama Vatha vruddhi/ kabha ksaya
Adhishtana Marmasthi sandhi
Avastha vyakthi
Doshajanya vikara-- Vatha
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Sadhyasadhyata
Incurable (Anupakrama/yapya)due to
Vatavyadhi/thridoshajanya
Associated with dhatukshaya,
samkocha etc.
Involvement of madhyamarogamarga &
progressive.
kulajadosha
Karmaja
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• No reference of a disease in classical books
having selective involvement of motor
functions and similar to motor neuron
disease.
• However we can consider this disease
phenomena as sarvanga Vata with vyana
vaikalya.
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Treatment programme
1.Amapachana/srothosodhana
2.Vathanulomana/Brumhana
a)Sneha sweda(Purvakarma)
b)sodhana-virechana /vasthi/nasya
c)Samsarjana krama
d)Samana /Kerala specialities
3.Resayana
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Case No-3
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Photographs of patient
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