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‘Motor Neuron Disease,

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:

no sensory loss or cognitive loss


(c.f. multiple sclerosis )
sphincters are never affected
ocular muscles are never affected
(c.f.myasthenia gravis)

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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

Amyotrophic lataral sclerosis


Combination of distal and proximal muscle wasting and
weakness,fasciculation
Spasticity,exaggerated reflexes,extensor plantar
Bulbar and psuedo bulbar palsy follow eventually
Pyramidal tract features may predominate

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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

 Eventually, the patient will be unable to


move, eat, or breathe without assistance.
Without supportive care, an individual will
pass away. Despite the best of care
currently available, complications of the
respiratory system are the most common
causes of death.

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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

 The prognosis of motor neuron disease is


based on the type.
 Generally, PMA and ALS progress to bulbar palsy,
which is eventually fatal. The prognosis is therefore
based on how long the conditions take to progress to
bulbar palsy, as follows:
 progressive muscular atrophy: 5 - 8 year survival
 amyotrophic lateral sclerosis: 2 - 5 year survival
 progressive bulbar palsy: less than 2 year survival

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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?

What is the line of treatment being


adopted?

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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)

“Dosha eva hi sarvesham


roganameva karanam”

 Disease is the outcome of the imbalance of


doshas.

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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

Anukthamapi doshanam lingairvyadhimupachared”

(Sushrutha samhitha)

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 “Adrushta desa kaladi parinamadanekadha
Puranapravileyanthe naveena pradurasathe
Vibhidyathe sthithaschadha
nrunam nanavidhagada:”
(Sidhantha Nidana)

“According to the changes occurring in


place,time,environment,
living conditions etc,
old diseases may disappear and new
ones may appear” .
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Important symptoms of MND
 Balakshaya (Weakness)  Aniyanthritha hasarudadi
(Emotional lability)
 Sphurana (Fasciculation)
 Swaithya (Whiteness of the
 Mamsasosha (Wasting) skin)
 Vakvikruthi (Dysarthria)  Sthambha (Spasticity)
 Minminatwa  Lalasrava (Salivation)
(Hypernasality)
 Bhaktharodha (Dysphagia)

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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

 Age of patient -64 Years


 Sex –Male
 Duration of disease—9 months
 Presenting complaints-Weakness and wasting of
muscles both upper limbs
 Stiffness and swelling of fingers and palm.Loss of grip
strength.
 Fasciculation
 Diagnosis-MND- Progressive muscular atrophy
 Physical examination-Poorly built,emaciated,
Normotensive,No diabetic
 DTR-sluggish

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Photographs of patient

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