1. Epilepsy: thunderstorm in the brain An analysis from Western medical and TCM viewpoint March 2016, Elske Altena Shenzhou Open University of TCM

2. Structure of presentation  Western medical viewpoint on epilepsy Definition and occurrence Diagnosis and causes Triggers Symptoms First Aid Treatment  TCM viewpoint on epilepsy Aetiology and pathogenesis Main patterns Important points regarding epilepsy Ear acupuncture  Sources  Questions

3. Definition and occurrence  Brain disorder that causes seizures  Disturbances in the electrical activity of the brain resemble a thunderstorm  Can develop in any person at any age  50 million patients worldwide  1/3 less than one seizure a year 1/3 one seizure a year 1/3 has more than one seizure a month

4. Diagnosis and causes  Two or more seizures  Further diagnosis Description of the attacks EEG MRI Additional urine-, blood-, cardiological or neuropsychological research  Cause unknown for about half of the patients

5. Two types of epileptic-syndromes  Idiopathic epilepsy Cause unknown No indication of previous brain damage Cause is likely to be genetic  Symptomatic epilepsy Also classified as secondary Caused by another health condition such as o brain tumour o infection of the brain o trauma of the brain o circulation-disorders o metabolic disorders o genetic syndrome

6. Other causes  Disbalance between excitatory and inhibitory neurotransmitters  Mental disability Of all the people with mental disability 30% has epilepsy  Schizophrenia  6 times larger chance on epilepsy Epilepsy  8 times larger chance on schizophrenia

7. Triggers  Specific time of day or night  Sleep deprivation  Fevers or other illnesses  Flashing bright lights or patterns  Alcohol or drug use  Stress, emotional factors  Menstrual cycle or other hormonal changes  Not eating well, low blood sugar  Specific foods, excess caffeine

8. Symptoms  Over forty types of epileptic seizures  Two main categories primary generalized seizures partial seizures The difference is in how and where they begin.

9. Primary generalized seizures  Widespread electrical discharge  Both sides of the brain at once Absences Epileptic signs during infectious-diseases Tonic-clonic seizures o Strange sensory sensations o Loss of consciousness o Convulsions o Eyes roll back or close, tongue bruises, foaming saliva o Blue lips or extremities o Incontinence Status epilepticus Cramps and unconsciousness remain  risk of brain damage and death

10. Partial seizures  Limited area of the brain  limited symptoms  Simple partial seizure Small part of one of the lobes  person remains conscious  Complex partial seizure Larger part of the hemisphere  person may lose consciousness  Secondarily generalised seizure Loss of consciousness and probably tonic-clonic seizure

11. First Aid  Most seizures end within a few minutes Make sure the patient is safe Stay with the patient Talk in a calm and comforting manner Don’t try to hold the patient down More than 5 minutes  get medical help & press/needle DM 26  After the seizure Plenty of water to drink Patient can be confused

12. Treatment  Medicine  Surgery  Dietary therapy  Vagus nerve stimulation  Deep Brain Stimulation

13. TCM viewpoint

14. Aetiology and pathogenesis  Mentioned in Chinese medical texts over 2000 years ago  Xin-Heart related  Two principal pathogenic factors Phlegm in the upper body Obstructs the Heart Shen and causes impairment of consciousness Liver wind Gives rise to seizures  Relationship with fear and fright and dysfunction of the Liver

15. Phlegm obstructing the Heart  Phlegm causes all attacks of epilepsy  Phlegm obstructing the Heart can arise because of 1.Excess of one of the five emotions 2.Stagnation of LR-Qi 3.High fever 4. Fright “The Shen leaves its residence, and when the residence is empty, the fluids will form phlegm.” (Gong Ju-Zhong in ‘A spot of snow on a red hot stove’)  The Heart is misted by phlegm and the Shen is disturbed

16. Syndrome pattern differentiation  Zang-Fu involved are mainly the Liver, Spleen, Kidney and Heart  Main patterns 1.Liver wind complicated with turbid phlegm 2.Liver fire with phlegm heat 3.Liver and Kidney Yin deficiency 4.Spleen and Stomach deficiency

17. 1. Liver wind complicated with turbid phlegm  Clinical manifestations Dizziness, vertigo Stiffness of the neck, oppression in the chest Sudden collapse Locked jaw, upward staring eyes Convulsions, salivation, shouting, crying Loss of consciousness without convulsions  Tongue : white or yellow sticky coating  Pulse : wiry and slippery  Pathology Liver wind stirs up internal phlegm  rises upward and mists the Heart Convulsions  Liver wind predominant Loss of consciousness without convulsions  phlegm predominant

18. Acupuncture treatment  Treatment principle Extinguish wind and resolve phlegm, unblock Heart orifices, strengthen Spleen  Main acupuncture points DM 26 (Renzhong)Revive consciousness LR 3 (Taichong)Subdue Liver wind to relieve spasm GB 20 (Fengchi)Extinguish LR wind, benefit the head DM 20 (Baihui)Pacify wind, subdue Yang, calm the mind GB 34 (Yanglingquan)Relieve spasms and convulsions PC 5 (Jianshi)Calm the mind and transform phlegm/unblock Heart RM 15 (Jiuwei)Regulate Heart, calm the mind in case of phlegm obscuring the Heart ST 40 (Fenglong)Clear phlegm from the Heart, calm the mind BL 20 (Pishu)Strengthen Spleen  In case of locked jaw add SJ 5 and ST 6, upward staring eyes BL 2

19. 2. Liver fire with phlegm heat  Clinical manifestations Mild or severe seizure Irritability Restlessness Insomnia Bitter taste in the mouth, thirst Difficult expectoration of yellow phlegm  Tongue: red body with a yellow coating  Pulse: wiry, rapid and slippery  Pathology Hyperactivity of LR-Qi  irritability Disturbance of the mind by fire  mental restlessness and insomnia Heat from Liver fire condenses body fluids into phlegm  phlegm rises and blocks the Heart orifices

20. Acupuncture treatment  Treatment principle Clear Liver fire, resolve phlegm, unblock the Heart orifices  Main acupuncture points DM 26 (Renzhong) Revive consciousness LR 2 (Xingjian) Clear LR-fire, extinguish LR-wind PC 8 (Laogong) Clear heat from the Heart, revive consciousness, calm the mind GB 13 (Benshen) Eliminate wind, resolve phlegm ST 40 (Fenglong) Clear phlegm from the Heart, calm the mind RM 15 (Jiuwei) Regulates Heart, calms the spirit in case of phlegm obscuring the Heart HT 7 (Shenmen) Regulate and tonify the Heart and calm the mind KD 1 (Yongquan)Calm the mind, revive consciousness, nourish water/subdue fire GB 34 (Yanglingquan)Relieve spasms and convulsions

21. 3. Liver and Kidney Yin deficiency  Clinical manifestations Mild seizures Insomnia Poor memory, pain and weakness of the lower back and knees Dizziness, vertigo  Tongue: red body with scanty coating or without coating  Pulse : rapid and fine  Pathology Yin deficiency of LR and KD  hyperactivity of Liver Yang  disturbs the mind, gives rise to insomnia and generates wind causing epileptic seizure

22. Acupuncture treatment  Treatment principle Nourish Liver and Kidney yin, subdue Liver yang and calm the mind  Main acupuncture points BL 18 (Ganshu)Tonify/regulate LR BL 23 (Shenshu)Tonify KD/nourish KD Yin KD 3 (Taixi)Nourish Kidney Yin SP 6 (Sanyinjiao)Harmonise LR and tonify KD, resolve dampness, calm the mind DM 20 (Baihui)Pacify wind, subdue Yang, benefit the brain, calm the mind DM 8 (Jinsuo)Relieve spasms, pacify wind, soothe LR GB 34 (Yanglingquan)Relieve spasms and convulsions RM 15 (Jiuwei) Regulates Heart, calms the spirit in case of phlegm obscuring the Heart AnMianPromote peaceful sleep

23. 4. Spleen and Stomach deficiency  Clinical manifestations Prolonged history of mild or severe seizures Lassitude, fatigue Low appetite, nausea, emaciation Lustreless complexion Loose stools Poor memory, vertigo and dizziness  Tongue : pale body  Pulse: soft and fine or soft and weak  Pathology Spleen deficiency  Qi and blood deficiency and production of phlegm  mind is not nourished, clear qi unable to rise due to phlegm accumulation and lack of qi and blood

24. Acupuncture treatment  Treatment principle Strengthen the Spleen/Stomach, resolve phlegm, tonify Qi and Blood, nourish Heart  Main acupuncture points DM 20 (Baihui)Pacify wind, subdue Yang, benefit the brain, calm the mind BL 20 (Pishu)Tonify Spleen, resolve dampness ST 36 (Zusanli)Tonify Spleen and resolve dampness, tonify Qi and nourish Blood RM 4 (Guanyuan)Tonify Qi and tonify Spleen RM 12 (Zhongwan)Tonify Spleen and Stomach ST 40 (Fenglong) Clear phlegm from the Heart, calm the mind HT 7 (Shenmen)Regulate and tonify the Heart and calm the mind BL 15 (Xinshu) Promote Heart Qi and calm the mind LR 3 (Taichong)Subdue Liver wind to relieve spasm

25. Important points regarding epilepsy  SI 3 SI interiorly/exteriorly related to the Heart  stores the spirit SI 3 is the confluent point of the Du Mai (mediates between brain and Heart)  BL 62 Confluent point of Yang Qiao Mai (for daytime epilepsy) Sun Si Miao Ghost-point Bladder primary channel enters the brain Bladder divergent channel links with the Heart + ability of BL 62 to pacify wind  special effect on epilepsy  SJ 10 Resolving phlegm Internal/external relationship of San Jiao and Pericard channels  important with disturbance of the Shen

26. Other important points regarding epilepsy (2)  SP 4 Luo-connecting point on Spleen channel that connects to the Heart. Luo-points on Yin-meridians have an important effect on psycho-emotional disorders.  KD 6 night-time epilepsy  Shi Shen Cong calm the spirit and pacify wind  Shi Xuan revive consciousness, drain heat and pacify wind  Yin Tang pacify wind and calm the Shen  Yao Qi 2 cun directly above the tip of the coccyx  The thirteen Ghost points of Sun Si Miao were listed in the 7 th century for the treatment of mania disorder and epilepsy. They are: DM 16, DM 23, DM 26, RM 24, LU 11, LI 11, ST 6, SP 1, PC 7, PC 8, BL 62, HaiQuan (below the tongue) and RM 1

27. Ear Acupuncture  Shen Men Location on the ear where a vagus nerve runs  Other points that can be useful are Stomach Subcortex Heart Brain Occiput

28. Sources Books Peter Deadman, Mazin Al-Khafaji and Kevin Baker A Manual of Acupuncture (Journal of Chinese Medicine Publications, 2013) Skya Gardner-Abbate Holding the Tiger’s Tail: An Acupuncture Techniques Manual in the Treatment of Disease (Southwest Acupuncture College Press, 1996) J.W. van der Krans Inwendige geneeskunde (Utrecht/Zutphen, ThiemeMeulenhoff, 2004)

29. Articles Mazin Al-Khafaji, Peter Deadman and Tim Martin Some Acupuncture Points Which Treat Phlegm Disorders (Journal of Chinese Medicine, number 39, May 1992) Peter Deadman and Mazin Al-Khafaji A Brief Discussion of the Points of the Window of Heaven (Journal of Chinese Medicine, number 43, September 1993) Peter Deadman and Mazin Al-Khafaji The Treatment of Psycho-Emotional Disturbance by Acupuncture with particular reference to the Du Mai (Journal of Chinese Medicine, number 47, January 1995) Hila Ravid, Shai Ravid and Reuven David Epilepsy: A Case Study Comparing Western and Traditional Chinese Treatment Procedures (Journal of Chinese Medicine, number 80, January 2006) Dr. Su Xin-Ming The treatment of Epilepsy by Acupuncture (Journal of Chinese Medicine, number 20, January 1986)

30. Websites https://www.epilepsie.nl http://www.farmacotherapeutischkompas.nl https://www.hersenstichting.nl/alles-over hersenen/hersenaandoeningen/epilepsie http://www.epilepsy.com/learn https://www.neurologie.nl/publiek/patientenvoorlichting/epilepsie https://nl.wikipedia.org/wiki/Epilepsie http://www.who.int/mediacentre/factsheets/ https://theory.yinyanghouse.com http://www.sacredlotus.com/go/acupuncture/point/yao-qi-on-the-back

31. Questions? Thank you for your attention!