A case of trigeminal neuralgia treated by Synthesis Repertory

Abstract:

In the following article, a case of 40 years women suffering from trigeminal neuralgia, is discussed which was treated with holistic approach of homoeopathy with the help of Synthesis Repertory.

Abbreviations:

International Headache Society (HIS), twice a day (BD)

Introduction:

Trigeminal neuralgia is defined as a sudden, usually unilateral, severe, brief, stabbing, recurrent episode of pain in the distribution of one or more branches of the trigeminal nerve (International Headache Society, IHS)⁽¹⁾. Trigeminal neuralgia or tic douloureux is neuropathic disorder of trigeminal nerve.⁽²⁾

         Age group: 37 to 67 years

         Sex: Women are affected 3 times more than men

         Maxillary and mandibular branch is more affected than ophthalmic.

        Involvement of branch:   1. Maxillary: 60%

                                                   2. Mandibular: 49%

                                                   3. Ophthalmic: 16%

                                                   4. All 3 divisions: 1% trigeminal nerve. ⁽²⁾

Homoeopathy is the primary choice of therapy for trigeminal neuralgia as homoeopathic treatment has shown an overwhelming response in the treatment of trigeminal neuralgia on the basis of  individualistic approach, minimising the frequency, the duration, and the intensity of pain.

Case presentation:

Chief complaints:

              A 40-year women came with the complaint of pain over the right side of face extending to ear for last 6 months. The pain was sharp, stabbing, aggravated from touch, cold, night. She used to feel sleepy after eating.

          History of presenting illness:

            Pain started 6 months ago, but intensity increased from last 3 days. Sharp, stabbing pain used to come at about 5 minutes interval and disappeared within a minute. She took conventional treatment earlier but no improvement.

       Past history:  viral hepatitis at the age of 24 years, treated with homoeopathy

       Family history: not specific

       Personal history:

         Diet was irregular, loved travelling. She took anti-hypertensive medicines regularly.

      Physical generals:

         The patient was restless and couldn’t stay in place. But she wanted to share her feeling with everyone. She wanted to know different unknown things and preferred to live with her family members. She had great apprehension at night.

         While enquiring her physical general aspects, it was found that her appetite was normal, desire for milk. Her tongue was red, she used to take plenty of water. She could not bear cold. Her stools were satisfactory, no complaints in urine. Sweat was normal. All complaints were relieved by motion and at night.

    Diagnosis:

          Diagnosis was based on clinical symptoms and physical examination of the patient according to International Headache Society criteria:⁽²⁾

   Miasmatic analysis:

1. Sharp, stabbing pain- PSORA
2. Aggravation from cold- PSORA       
3. Aggravation at night- SYPHILIS
4. Restless- PSORA
5. Desire for milk- PSORA
6. Apprehension at night- PSORA
7. Prefer company- PSORA
8. Wants to travelling- PSORA, SYPHILIS

  Analysis and evaluation of symptoms:

S. No.	Symptom type	Symptom	Intensity
1.	Mental general	Restlessness and couldn’t stay in one place	+++
2.	Mental general	Wanted travelling	++
3.	Mental general	Prefer company	+
4.	Mental general	Great apprehension at night	+++
5.	Physical general	Desire for milk	+++
6.	Physical general	Desire for plenty of water	++
7.	Physical general	Red tongue	++
8.	Physical general modality	Complaints relief on motion	+++
9.	Physical general modality	Night aggravation	++
10.	Physical general modality	Aggravated from cold, talking	++
11.	Physical general modality	Sleepy after eating	+++
12.	Particular symptom	Pain in the right side of face, extending to ear	+++
13.	Common symptom	Sharp, stabbing pain	+++

Totality of symptoms:

1. Restlessness and couldn’t stay in one place
2. Wanted travelling
3. Great apprehension at night
4. Desire for milk
5. Tongue was red
6. Complaints relieved from motion
7. Felt worse at night
8. Pain in the face extending to ear

 Repertorial totality:

The following mental general, physical general, and particular symptoms were taken into consideration, and repertorisation was done with the help of Synthesis Repertory (Radar opus 10.0)⁽³⁾

Symptom	Rubric
Restlessness	MIND-RESTLESSNESS
She wanted to travelling	MIND-TRAVELLING, desire for
Great apprehension at night	MIND-ANXIETY, night
Desire for milk	GENERAL-FOOD & DRINK, milk, desire
Tongue was red	MOUTH-DISCOLORATION, Tongue, red
All complaints relieved from motion	GENERALS-MOTION, amel.
Felt worse at night	GENERALS-NIGHT
Pain in the face extending to ear	FACE-PAIN, extending to, ear

Repertorisation:⁽³⁾

Prescription:

Prescribed on 08/05/2020

Rhus toxicodendron 200/ 2 doses, early morning mixing with ½ cup of water for 2 days along with placebo every day, two times after eating for 7 days.

After repertorisation, Mercurius solubilis, Rhus toxicodendron came up with highest mark and Arsenicum album, Belladonna, Calcarea carbonica possess second highest mark. But Rhus toxicodendron was selected on the basis of mental as well as physical symptoms of patient.  In this case, patient was much restless with apprehension, and she felt sleepy after eating. After consulting materia medica⁽⁴⁾⁽⁵⁾and repertory, Rhus toxicodendron was indicated remedy. So, Rhus toxicodendron was selected for this case.

Selection of dose and potency:

As per Organon of Medicine, aphorism 247 5^th edition,⁽⁶⁾ and according to the susceptibility of the patient, potency was selected. Here the patient’s susceptibility was high and intensity of the symptoms was also high. Since she suffered from long time due to that affection, so the case was started with higher potency.

Follow up:

Date of visit	Response	Medicine prescribed
11/05/2020	Severe pain in the right side of face, lasting 2-3 minutes	Rubrum-30/1 drop     BD x 5 days
15/05/2020	In last 3 days, there was no attack. Patient felt better. Sleep was normal, 8-9 hours	Nihilinum-200/1 drop     BD x 7 days
22/05/2020	Yesterday again, pain came but duration was less than previous	Lactopen-1M/1 drop     BD x 5 days
29/05/2020	No pain for about 3 days. Patient was much happy and feltbetter	Nihilinum-200/1 drop     BD x 7 days
08/06/2020	No occurrence of pain	Rx    Phytum-30/ 1 drop    BD x 15 days

Advise:

 Patient was asked to avoid cold exposure, take nutritious diet and avoid spicy food.

Conclusion:

Homoeopathy is an artistic and holistic treatment for such kind of a case. If the medicine is selected according to the symptom similarity and individualisation, most of the cases are curable. One must emphasise on the totality. With the help of homoeopathic treatment, the intensity and the frequency of pain gradually diminished, and ultimately the patient completely recovered from so-called TRIGEMINAL NEURALGIA.

References:

1. Mojaver YN, et al, Individualised Homoeopathic Treatment of Trigeminal Neuralgia: An observational Study, Homoeopathy, 2007, vol-96, pp- 82-86
2. Davidson, Principle & practice of Medicine, 19^th ed. London: Churchill Livingstone; 2002
3. Synthesis Repertory 9.1 (Radar Opus 10.0)
4. Allen HC, Allen’s Keynote Rearranged & classified, 10^th ed. New Delhi: B.Jain publishers (P) Ltd.; 2013
5. Boericke W. Boericke’s New Manual of Homoeopathic Materia Medica & Repertory, LPE ed. New Delhi: B. Jain Publishers (P) Ltd.; 2014
6. Hahnemann S, Organon Of Medicine, 5^th & 6^th ed. New Delhi: B. Jain publishers (P) Ltd.; 2016