Cerebral Palsy and Ayurveda

Introduction

Cerebral Palsy (CP) is a commonest chronic motor disorders in children with considerable morbidity and affect about 3-8% of the population with 15-20% of physically disabled children and incidence of 3/1000.(WHO ) [1, 2, 3, 4]. This affects 2.1 per thousand live births more among poor and male and prevalence average rate is of 2 per thousand most commonly in low birth weight babies. Its incidence increases with premature and low birth weight babies regardless of quality of care. On n the basis of part affected Cerebral palsy being classified as-Monoplegia, Hemiplegia, Diplegia and quadriplegia out of which diplegia is the commonest (30-40%), Hemiplegia (20-30%),quadriplegia (10- 15%),Spastic quadriplegia 61% and diplegia 22% Out of which spastic Cerebral Palsy is the commonest and accounts to 70-75%, dystonic 10-15% and ataxic <5% [5, 6, 7, 8]. Cerebral palsy is not a progressive disorder but manifestations become more prevalent over time and are more likely to have learning disability without affecting IQ including varying degree of intellectual disability with significantly reduced life expectancy depending on severity of condition & quality of care. 5-10 % of children with Cerebral Palsy die in childhood particularly who had seizure and intellectual disability [9, 10, 11, 12]. The ability to ambulate, roll and self feed are the index of increasing life expectancy, in addition independent gross motor functional ability is a very strong determinants of life expectancy [13, 14]. The most accurate index of assessment of general movements occurring spontaneous before 4 months age [15, 16].

• Abdominal muscle tone
• Delayed motor development
• Persistence of primary reflexes
• Typical symptoms suggestive of diagnosis most commonly occurs at the age of 2 years Therapeutic outcome in Cerebral Palsy depends on the age of diagnosis, as early the diagnosis better is prognosis. The present study is based on the hypothesis that neural tissue remains same ,as it never grows or multiply after birth and no available modern molecule can regenerate or repair damaged or diseased nerve cells thus a herbal composite of proven efficacy in helping repair and rejuvenation of nerve cells been evaluated in cases of Cerebral palsy. Ethical Status: Ethical committee of National Institute of Health & Research approved the extended study to approve the established neurogenic effect of herbal composite

Observations

Among 184 selected patients 116 were male and 68 were female, out of all 51 cases were of age <1 year while 71 were of <3 years though 6 cases were of >5 years age (Table 6), (Figure 1). Out of all 96(52.2%) were delivered normally while 51(27%) through caesarean section and 100(54.3%) were with poor Apgar score and 84(41.6%) with low birth weight (Table 7). Among the selected patients 62 had taken various therapeutic including physiotherapy in last few years without having any improvement while rest 122 have not taken any medication and attended the centre for the first time, though 69 cases were detected during the treatment for other disease (Figure 2). The commonest clinical presentation was speech problem in 82.6% cases while 52.7% presents with microcephaly, 44.8% with seizure and 12% with behaviour problem (Table 8). Birth history reveals majority (64) with low birth weight, 59 premature delivery and 61 with poor Apgar score (not cried after birth). Considering the severity of the presentation 32 were of severe, 60 moderate and 92 with mild grade of presentation (Figure 3). No patients had any drug adversity or agonizing clinical presentation or any alteration in haematological, hepatic and renal function though 98.9 % patient show marked rise in haemoglobin (Table 9). Out of all 178 (96.7%) children shows grade I (excellent) clinical outcome while 4(2.1%) and 2(1.1%) had grade II and grade III improvement (Table 10), (Figure 4).

Click to enlarge

Click to enlarge

Click to enlarge

Click to enlarge

Results

Cerebral palsy a chronic condition with considerable morbidity more in male and in lower middle class due to health ignorance unhygienic environment and lack of proper antenatal and obstetric care having increased risk multiple birth, neonatal asphyxia and premature delivery. Common symptoms and associated conditions observed in spastic quadriplegia and convulsive disorders [19, 20, 21]. As no effective treatment for the underlying brain damage and all sophisticated technology are highly expensive and complicated therapies in the medical research field find a definite cure for the disease. The present study reveals grade I clinical response in majority of early cases and improved quality of life in all the selected cases taking herbal composite NEUROVIT can be explained as - Physical and mental debility due to hypoxia, loss of GABA mediated inhibition of dentate granule and death of GABAergic inhibitory neuron results in attenuation of inhibitory control which in turn results in hyper excitation of the remaining neuron of the hippocampus.

Mossy cells (located in dentate hilus, a part of hippocampus) are extremely sensitive to seizure induced neuronal death and damage following intense synaptic activator i.e., excite-tonic mechanism of activator of NMDA (N methyl D aspartate) a sub type of glutamate receptor which results in excessive intracellular calcium. Release of cellular zinc attenuate GABA response and induce hyper -excitability of neurons. GABA binds to GABA-A(coupled to calcium/chloride channel and a main target of currently prescribed drugs) as excitatory post synaptic potential are the main form of communication between neurons and is mediated by release of excitatory amino acid-Glutamate from presynaptic elements which is mediated by - NMDA (N methyl D aspartic acid/aspartate) - AMPA(Alpha-amino-3 hydroxy 5 methyl isoxazole propionic acid) kinate - Metabotropic GABA-B (Couples to potassium channel, a cause of latency and long duration of action) located in pre-synaptic element of an excitatory pre-neuron and inhibits pre-synaptic neuron by - direct induction of IPSP - inhibition of release of excitatory neuro transmitters Hence clinical supremacy of the adjunct indigenous composite can be attributed to bioregulative action of indigenous composites active ingredients for GABA neurodynamics i.e., Nardostachysjatamansi (Jatamansin, Jatamanose, Nardostachine) Herpestismonnieri(Monnerein) bio regulate GABA biokinetics and prompt neurovigorative while Acorus calamus (Acorin, Beta asarone and calaminidine) and Crotolariaverrucosa (crotallidine and verrucosin) acts as a neurogenic and helps in regeneration and repair of damaged neuron due to epileptic attacks thus improve and check neural debility and alleviate physical disability . In addition Convolvulus pluricaulis (Covolvulin) and Herpestismonnieri (Bacoside A & B) both promote neural growth due to activation of nerve growth factor-Tyrosine kinase A receptor, preserve m RNA level of muscarnic receptors and check accumulation of lipid and protein damage, thus improve both mental ability and capability. Hence bio regulation of altered GABA neuro kinetics prompt neurogenic action improve mental capability and physical capability [22, 23]. Active ingredients of the composite help revitalization of the damaged or diseased nerve cells ,improve neuro transmission by bio regulating neuro transmitter secretion ,not only improves physical status i.e.- relieves paresis, improves muscle power, increases muscle bulk and improve deep tendon reflex ,in addition also improves mental capability and IQ (Figure 5).

Click to enlarge

Thus NEUROVIT herbal composite seems to be a boon for Cerebral palsy cases in improving quality of life restricting handicap and improving mental capability., earlier the supplement better the outcome.

Conclusion

Cerebral palsy having no proven therapeutics in modern medicine shows promising result with herbal composite of proven neurogenic and neuro vitalising capacity in cases of cerebral palsy detected at early age i.e. <2 years while patients detected late Or tried various medication presenting with severe spasticity, have improvement in presentation i.e. muscle power and tone, spasticity and mental ability.

Thus this Herbal composite NEUROVIT is worth prescribing either alone or as an adjuvant in cases of Cerebral palsy as early as possible.