Aspects of Epilepsy and Methods of Its Treatment in Pediatrics
By: Rene Madeleyn
*Original title: Gesichtspunkte zur Epilepsie and deren Behandlungsmoglichkeit bei Kindern. Der Merkurstab 1990; 43: 369-84. English by A. R. Meuss, FIL, MTA
The aim of this paper is to present the experience gained in treating epilepsy anthroposophically in the Pediatric Unit at Herdecke Community Hospital. A brief summary is given of Rudolf Steiner's statements relating to epilepsy, other papers on the subject are reviewed, and an attempt is made to find aspects in the case records discussed with Steiner that may take us further. I believe these records have not been given adequate consideration to date. My thanks to my colleagues in the Pediatric Unit who relieved me of the routine clinical work for some weeks to enable me to write this paper.
Epilepsy in the works of Rudolf Steiner
The fullest and most complete discussion of epilepsy was given in the third lecture of the Curative Education course.1 Beginning with a waking up process, Steiner spoke of the way the I-organization and the astral body do not adequately penetrate one or more organs as they enter into the physical and ether bodies to take hold of the outside world — if there is an epileptic constitution — so that they are held fast. The seizure reflects such internal disorders on the surface of an organ. If the I-organization and astral body do not relate adequately to the forces of equilibrium, vertigo develops. The treatment recommended is: balancing exercises in gymnastics or eurythmy using dumbbells or suitable weights.
If the watery element cannot be properly taken hold of, nausea is experienced. The recommended treatment is to get the child to taste its food more, e.g. by adding seasonings, and to learn to swim.
If the air is not fully taken hold of, conscious awareness is reduced and Steiner advised carefully monitored breathing exercises. Unfortunately, he did not go into detail about this. More about this later.
Symptoms indicating problems relating to warmth were not mentioned, but the advice given was to dress epileptic children in a way that would make them tend to sweat rather than be cold.
These phenomena indicate that the I-organization is unable to relate properly to the elements. Moral symptoms such as violence in children indicate that the astral body does not relate properly to the outside world. In this case, treatment is mainly medical.
Two children with epileptic seizures are discussed in detail in the 7th and 10th lectures of the course. In a lecture given on 20 October 1922,2 reference is made to "ordinary infantile convulsions". These are probably the febrile seizures seen in up to 4% of children, mainly in the early years of life. Astral organism and I are vibrating too fast into the human being of metabolism and limbs; the astral pushes through the etheric, resulting in seizures. Compared to the situation described in the Curative Educationcourse, the cause is not impenetrability of the organs in this case but excessive vehemence in the waking up and taking hold of the body process. The boisterousness of children at this age may be seen to indicate excess activity in mind and spirit. The "emotional spasms" that develop when children are wrought up or in a great rage and suddenly stop breathing, turn blue, lose consciousness and sometimes develop convulsions also indicate that the physical and ether bodies are not able to absorb the excess astral activity of high emotion. This brings these seizures close to the childhood diseases. Scarlet fever and measles, in particular, reflect a struggle between soul and spirit on one hand and hereditary forces on the other. I and astral body establish a new relationship to physical body and ether body. Going through the crisis, the child takes another step forward in taking hold of the living body.
Rudolf Steiner described the nature of childhood seizures from a different point of view in a lecture given to building workers.3 He was speaking of children who do not have the strength to get nutrients from the intestine to the blood. This may lead to diarrhea and diarrhea plus vomiting. If foods are not properly processed for an extended period, the internal organs do not develop properly, e.g. the lung may appear as an empty bag. The powers to develop it are there but not the material that is needed. The head, Steiner said, would then be gesticulating wildly all around the organism, as it were, and not be able to gain a proper hold in the lung or other organs. This would lead to seizures. The powers of the head might also be considered to be powers of coming awake, and if the internal organs are not developed and given substance, they could not give them the necessary basis on which to take hold of the body. An inner relationship can be seen between this and Steiner's discussion of medicinal Carbo and Hyoscyamus actions in the treatment of seizures.
In a lecture on 26 August 1906,4 Steiner said that children may get a shock when looking ahead to the coming life on earth in early embryonic development and that this may give them a disposition to epilepsy. This has helped me to understand the destinies of some children suffering from seizures.
In chapter 15 of Extending Practical Medicine,5 epileptic states are ascribed to irregular function of the astral body in its effects on the blood circulation.
This is primarily evident from abnormal cardiac activity. These words cannot immediately be reconciled with the way Steiner spoke about epilepsy in the Curative Education course. I am under the impression that a syndrome such as hyperventilation tetany may be seen in this light. I'll not go into the treatment suggested in the chapter at this point.
Chapter 19 gives nine characteristic case histories to show how one moves from spiritual-scientific diagnosis to treatment. The fourth case is that of a girl aged 5 1/2 with a history of spastic paralysis and seizures. The latter had subsided by the time Ita Wegman and Rudolf Steiner were consulted. A number of pathological symptoms shown by the child's mother and aunt are shown both to be related and due to incomplete development of the fetal membranes that feed the embryo in the child's grandmother. The child developed pylorospasm at 6 weeks. As soon as this spasmodic condition was cured, seizures developed at 8 months, with the child growing rigid and turning up her eyes.
We have seen such a metamorphosis of pylorospasm into epileptic seizures in an infant immediately after surgical treatment of the condition. This does not always happen, but it may suggest the need for follow-up treatment even if the operation has been successful and the symptom removed, using Cuprum, Chamomilla, Belladonna or Tabacum.
Further development of anthroposophical epilepsy treatment
A search through past issues of the journal, Beitrdge zu einer Erweiterung der Heilkunst, now Der Merkurstab, yielded six items on the subject of epilepsy.6-11 Rudolf Treichler published essays on the subject in Vom Wesen der Epilepsie,12 and Karl Konig gave three lectures on epilepsy and hysteria for special teachers and social workers in Berlin in 1965,13 basing himself on Steiner's fundamental thoughts in the Curative Education course. Little has been heard of the syndrome, and there appear to have been no further publications in the last ten years.
Scientists have made major advances in recent decades with the development of new anticonvulsants and the systematic classification of different seizure disorders with the aid of EEG records and a differentiated estimated prognosis. Most children with seizure disorders are seen in specialized outpatient clinics today, and this makes it possible to have far more of them than was possible in Steiner's day when phenobarbital and bromine were used, and it was not possible to monitor blood levels and have EEGs. This does, however, limit the opportunities for using anthroposophical medication on its own.
A number of colleagues, especially those working in anthroposophical special education institutions, have seen good results with anthroposophical medication, eurythmy therapy and special education measures, but it is difficult to keep accurate and systematic records of a disease that often continues for years. This may explain why there have so far never been more than three case records in any paper published. They were presented by Gertrude Walther in 1956,6 offering a number of important general suggestions for clinical management. Functional disorders in the liver, kidney and brain were diagnosed using Ehrenfried Pfeiffer's crystallization method and treated with anthroposophical medicines that act on the organs concerned. Anticonvulsants were not required for any of these children, and a cure was achieved. Unfortunately, the absence of EEG records makes it impossible to classify the cases and estimate the prognosis using the current system.
At the Herdecke Hospital, we have decided to do without the crystallization test for we feel it may be a problem to depend for a major intuitive element on someone who usually does not know the patient.
In 1965, Bertram von Zabern published two epilepsy case records 9 from the point of view of "malnutrition" and "softening of the brain", a term Steiner used in his lectures 14 to describe the different ethers taking effect in different ways and gaining dominance. Both patients were given anticonvulsants as well as anthroposophical medicines. Unfortunately, no suggestions for treatment were derived from seeing the condition within these polar extremes.
Walter Holtzapfel discussed the threefold nature of petit mal seizures.8 Infantile spasms, pyknolepsy and IPM have incidence peaks at different stages of childhood. The author relates the characteristics of each seizure to the special features of the period in life but does not draw conclusions as to treatment. Karl Konig also considered the relationship to different stages in life in his lectures and relates grand mal seizures to the sleep-waking rhythm.13 His lectures are full of life, showing how profoundly this condition affects all dimensions of our human nature. He appears to have left the treatment aspects aside deliberately, no doubt because he was speaking to a lay audience.
Heinz Hartmut Vogel11 and E. Giessler and W. Muller-Guffike (in letters to the editor)10 report two remarkable evolutions of patients suffering from seizures. Both patients were treated without using anticonvulsants.
The most extensive discussion of epilepsy from the spiritual scientific point of view appears in Treichler's book.12 He takes up Steiner's suggestion that the symptoms accompanying epilepsy may be ascribed to earthly powers of balance, of the watery, airy and warmth elements not being adequately taken hold of, and establishes relationships to organs, basing himself on the Curative Education course as well as the 9th and 11th lectures in Spiritual Science and Medicine,15 Steiner spoke of how lung, liver, kidney and heart relate to the elements. Treichler offers a whole range of suggestions out of his wide experience. Apart from Belladonna and Hyoscyamus as the main medicines for the epileptic process, they cover organ relationships and details concerning eurythmy therapy. Special problems connected with epilepsy in early childhood are only touched on briefly, but he shows how difficult it is to establish a differentiated organ relationship. The younger the child, the more all form-generating powers come from the head, with the whole organization subject to it. The whole child is a sense organ at that stage and, in the highest degree, open to environmental influences. The metabolic organs and the rhythmic organization only gradually develop their own dynamics.
Cases discussed with Rudolf Steiner
A total of 22 patients suffering from epileptic seizures were discussed with Rudolf Steiner, with all these discussions published by Hilmar Walter.16 Six are also included, some in shortened form, in the case records collected by A. G. Degenaar. Case Nos. 3, 101 and 103 are included in the Curative Education course; No. 98 is the fourth case discussed in Extending Practical Medicine. It has to be remembered that some of these are very incomplete and inaccurate records that were not intended for publication. Suggestions were often quite specific for a particular patient and cannot be applied to others. A study of these records nevertheless presents a number of general aspects that take us further, and these will be considered below.
Bromine, phenobarbital and the matter of results
In ten of the above cases bromine and phenobarbital, the two anticonvulsants then known, had been prescribed, probably by other physicians. Two patients were given anticonvulsants after the consultation with Steiner and Ita Wegman, four of them prior to it. Improvement on phenobarbital is mentioned only in case record No. 116, with no change in the others, except for one aggravation (No. 99). Steiner did not discuss these drugs in any of the cases, but in the discussion on the vademecum handbook (11 July 1922),17 the suggestion was made that bromine merely tones the whole human being down, while Belladonna makes the patient more open in all his sensory perceptions, which then "went straight at things".
Anticonvulsants always reduce the excitability of nerve cells. We can see their action to be such that they inhibit the process in which the body is taken hold of in the waking up process, with a seizure threatening because organs are not sufficiently permeable and astral body and I-organization dammed up. The whole organism is brought to a more sleep-like state. Some patients state that they feel more awake once anticonvulsants have been discontinued, even if they themselves and those around them have apparently seen no side effects before. Conversely, frequent seizures may, of course, reduce consciousness, and, in that case, patients may appear much more awake after successful anticonvulsant treatment in spite of having received them. We use anticonvulsants for symptomatic treatment, the aim being to relieve the organism of a seizure that may be too much for it, giving it time to develop self-healing powers and make the organs more permeable. This is possible, as may be seen from the fact that anticonvulsants can often be discontinued after a prolonged seizure-free period and there will be no recurrence.
All anticonvulsants have side effects, and in the individual case it has to be carefully considered if the medication will do more harm to the patient than the seizures. Deaths from liver failure due to exhibition of valproic acid have been repeatedly observed in recent years, and the drug is now used with more caution. Initially, expectations had been high as it has relatively few effects on mental function.
Freedom from seizures at any cost should thus not be the highest aim of treatment. Depending on the severity, duration and frequency of seizures a patient may sometimes live reasonably well with them, with development not affected. In my view, case No. 115 is particularly helpful for assessing progress. This was a Swedish male patient treated at the Institute of Clinical Medicine in Arlesheim from 28 June 1923 to 23 July 1924. He mainly had major seizures during the nights. In a total of four consultations, Rudolf Steiner changed the treatment when progress had not been satisfactory, but the previous treatment would always continue or the new treatment be connected with it. The spiritual scientist's basic concept appears to run through the whole course of treatment, with adjustments made to meet the real situation. The patient was later free from seizures, which had been one of Steiner's aims, but it needed perseverance. Today, it is, of course, more or less unthinkable to keep an epileptic patient in hospital for a year.
Apart from this case record, treatment was also shown to be evidently successful in cases 101, 104, 108 and 114. In some cases nothing is known about further progress. It also interested me to know to what extent Steiner used the measures he referred to in the Curative Education course.
Exercises to improve balance are not mentioned in the discussions, nor are swimming exercises. For the Swedish patient (No. 115) who complained of feeling as if he was seasick prior to a seizure, it was advised to add pepper to his food. This is the only reference I have found to seasoning food.
A rather puzzling suggestion was to do carefully-controlled breathing exercises where consciousness is primarily affected during seizures (essentially absences and psychomotor attacks) It is highly interesting, however, that absences may be triggered by hyperventilation, i.e. the individual "getting out of breath", with the typical patterns seen in the EEG.
Case No. 102 refers to a girl, age 12, with absences and spastic hemiparesis on the right.
Ita Wegman and Rudolf Steiner had known her for some time, and the advice had been to dress her in pink and pale blue on alternate days. Apart from medical treatment, external applications and eurythmy therapy, she was later given a meditation, asking her to look at a blue surface with three white dots in it and visualize the white changing to pink and then white again. I see these two measures as a kind of color breathing exercise, with the two colors relating to polar opposite inner moods.
The 26-year old patient in case No. 112 also had loss of consciousness with a feeling that something was wrong with his breathing and blood circulation. He was given a meditation to be done in the evenings and then backwards in the mornings. Medical treatment consisted in Plumbum 4x, on the next day Argentum 4x, then a day's interval. The two recommendations again suggest stimulation of the breathing process. We have tried to regulate the breathing of some patients with eurythmy therapy, winding and unwinding spirals, for instance, contraction and expansion, or LM.
For the 11-year old boy in case No. 101, Steiner advised Belladonna 10x injections, honey milk, and lime blossom tea to induce sweats. He said the boy's astral body was highly independent in its actions and not playing its proper role, failing to adapt to the ether body and physical body.
Medical treatment in the case records
The case records include a number of medical treatments that are unique, not known in the homeopathic treatment of epilepsy, and not explained. Examples are bitter almond juice 6x (No. 104), Corundum D15 (No. 107), or applying walnut juice 5% to the back of the head (No. 104). Belladonna runs through 13 case records like a silver thread. It and Sulfur had been recommended as a general medicament for epilepsy in the third lecture of the Curative Education course.
In the discussions on the vademecum handbook on 17 July 1922,17 it was said, on one hand, to act on the head tract if there are organic deformities, using the 15-60x, and on the will organism to get the patient to sweat and develop mildly febrile states.
In the case histories, Belladonna was recommended in 4x to 60x potencies, and in No. 116 as 0.025% ointment applied to the calves. On three occasions, injections of the 10x were given; 3 patients were given it in variable potencies, in case No. 103 actually ranging from 4x to 30x. This encouraged me to change potencies more frequently, or give it in low potency in the morning and high potency at night. In most cases, the reason for the choice of potency is not immediately apparent.
Hyoscyamus is related to Belladonna. We note its use in six case records, interestingly enough combined or alternating with Belladonna in five of them and with Aranea diadema in one. In the discussions on the vademecum handbook Hyoscyamus was recommended for "disorders in the lower tract". In case No. 109, it says that Hyoscyamus stimulates the lymph vessels in the intestinal villi to absorb more.
Another important point for understanding Hyoscyamus comes in a lecture given on 22 March 1923.18 Hyoscyamus is said to evoke an intense plant form to strengthen the ether body in the abdominal region. It creates a powerful negative, with the result that the brain is able to maintain its structure more effectively, and a person tending to states of clouded consciousness becomes free of these. I give Hyoscyamus especially to pale, restless children with dystrophic musculature.
Like Belladonna and Hyoscyamus, Agaricus muscarius is used by homeopaths to treat epilepsy. Rudolf Steiner used it in four cases (Nos. 102, 104, 105, 106), always in combination with Belladonna. This clearly shows that he ignored the homeopathic aspects, muscarine being an atropine antagonist, with the two drug pictures differing a great deal.
Treating the 12-year old girl with absences and spastic hemiparesis (No. 102), Steiner gave Agaricus 6x, the reason being that nerves had sustained direct damage. In a circular letter19 he advised injections of it to treat the sequels of encephalitis.
The nature of Agaricus also emerges from a passage in the 10th lecture in the Curative Education course following the discussion of a boy with epilepsy: "Algae and fungi are plants that live entirely in the interaction between air and the watery element. The peculiar aspect is that these plants are powerfully attracted to the very small quantity of sulfur widely found in both the water element and the air today. This makes them particularly suitable to create harmony between the astral body and the ether body by introducing them into the rhythmic organism."
Lead in the special Scleron preparation is one of the main medicines for sclerosis. The impermeability of organs to the astral body and I-organization may be seen as related to sclerosis. It is therefore not surprising to find that Steiner used lead in five of the epilepsy cases, twice in the form of Scleron (Nos. 99, 100), once in the 4x (No. 112), once as Plumbum chloratum 1:1000 injections (No. 111) and once in red lead baths (No. 115). A general statement on lead occurs in case record No. 99: "If you give lead to someone, the whole system of his sensory nerves grows more active, and he is induced literally to perceive his vessels . . .". We can perceive lead to be something that comprehensively supports the waking-up process.
A number of "neurodegenerative" conditions involve seizures, among them ceroid lipo fuscinosis, leukodystrophy, mucopolysaccharidosis. Specific metabolic products form deposits as they cannot be adequately metabolized and broken down, also in the nervous system, because of an enzyme deficiency. With tuberous sclerosis, which may cause highly treatment-resistant seizures, one sees actual calcifications in the brain. These conditions cause a general loss of physical and mental abilities even in childhood. I consider Plumbum to be indicated in them, using potencies from the 6x to the 20x, usually in the form of Phinibitni niellihini.
A 3-year old (No. 97) was given Carbo vegetabilis for epilepsy by Rudolf Steiner. (Unfortunately, nothing is known of the nature of the attacks.) Steiner considered the cause in this child to be a disorder of lymph production in the digestive tract. The 43-year old Swede (No. 115) was given Carbo 5% by mouth. In homeopathy, Carbo is used as a detoxicant. Steiner prescribed Carbo 5% for an adult who felt intoxicated. In this sense Carbo can also compensate the side effects of anticonvulsants.
Mistletoe and oak apple in the treatment of epilepsy
Mistletoe has a long tradition in the treatment of epilepsy; it was referred to in that capacity by Paracelsus, Lonicerus, Bock, Matthiolius and others. A summary of mistletoe indications is given by Madaus.20 Mistletoe is mentioned in conjunction with the development of epilepsy in the 13th lecture of Spiritual Science and Medicine.15
A young man suffering from epilepsy (No. 114) had been taking the Belladonna and Hyoscyamus Steiner had recommended for some time, but the seizures continued. Steiner finally prescribed mistletoe extract 5% to be taken by mouth in addition, and the seizures stopped. The Swedish patient (No. 115) was given Viscum mali 0.5%, then the 5x every second day by injection always seven times, followed by a week's interval.
I did not find mistletoe mentioned in any of the publications on anthroposophical epilepsy treatment. I first used it as Viscum mali 5x per os in combination with Hyoscyamus Rh 3x to treat a boy of 9 who was severely retarded, with motor unrest, and had about four epileptic seizures a day with loss of tone. His mother was against the use of anticonvulsants. The boy was free from seizures in a few weeks and in the years that followed would only rarely have one in particularly stressful situations. After this key experience, mistletoe became one of our main epilepsy medicines and has given good results in many cases.
The aim of mistletoe treatment for cancer is to envelop the tumor in warmth so that it will dissolve. It may be seen as having a similar, dissolving action on hardening in organs that prevents the body being properly taken hold of in the waking-up process, thus creating a disposition to epileptic seizures.
In my experience, it is important when using mistletoe to change the potency and mode of application if the effect is not adequate. I usually start with Viscum mali 5x per os, changing to the 3x or 2x if improvement is not satisfactory. Impressive progress was seen in a severely handicapped tetraspastic boy with frequent severe seizures in spite of being given Viscum per os. Daily injections of Viscum mali 2x gave noticeable improvement. Injections of the 3x given before that had not had this result.
The history of the Swedish patient (No. 115) showed most beautifully how Rudolf Steiner would metamorphose a therapeutic principle in the course of treatment. The patient had been an inpatient for six months and for three months had been given Viscum in series of 7 injections, but the seizures continued. Steiner advised to replace the Belladonna and Viscum injections and give oak apple 10x, again in a series of 7 injections. An important comment was that this was an utterly slovenly astral body which did not want to work in the physical body and the ether body.
What does oak apple have to do with mistletoe? Both are spherical in appearance and develop as a kind of foreign body on a plant. Oak apples develop when a gall wasp lays its eggs in the vegetative cone of a gall-oak bud. A hollow spherical form develops around the larva over a 6-month period. The cavity wall is covered with relatively thick oily nutrient layers that are slowly consumed by the insect. Thick layers of parenchymatous cells containing tannins and calcium oxalate develop on the outside. The tannin content is 25-45%. The almost fully developed insect gnaws a straight passage through the chamber wall and hatches.
Oviposition clearly is a kind of fertilization of a plant principle by an animal principle, and the oak responds by producing a uterus-like hollow organ, the oak apple. An astral principle coming from an animal interpenetrates with an etheric principle in the plant, and they condition one another. The whole process may serve as an image of the way tannins stimulate the astral body to extend its activity to the ether body. Rudolf Steiner spoke of this when discussing the treatment of asthma.21
Mistletoe has the strange feature of the etheric taking up the astral. In a lecture given on 8 August 1908, we read: "Mistletoe has something of an astral body which goes into the mistletoe the way it does in an animal body. Although it does not have sentience, it shows some kind of animal nature in its outer appearance. This is because it was one of those plant-animals on the Moon that had lagged behind."
We are now able to see the indication of oak apple and mistletoe treatment for the Swedish patient in a new light, the aim being to get the astral body to work better in the ether body and physical body. I have so far given oak apple as Gallae 6x dil. per osto two patients, to follow mistletoe treatment.
Further medicaments will be considered in the context of our case reports below.
Over the last 5 years, we have treated 54 children with seizure disorders in the children's wards and pediatric outpatients without using anticonvulsants. Let me first describe the situation that led to the decision not to use anticonvulsants. It is relatively easy to decide on this in the case of Jacksonian epilepsy. The seizures do not cause damage, and conventional medical treatment also often does not involve anticonvulsants. An opportunity is also created for anthroposophical treatment if there is treatment resistance or if anticonvulsant side effects are not tolerable in relation to the severity and frequency of seizures. Another factor may be great confidence in anthroposophical medicine and distrust of "chemical" drugs, so that, even with severe seizures, one is sometimes justified in at least making an attempt with purely anthroposophical treatment. This may prove surprisingly successful on occasion, which gave us further motivation.
To get an idea of the percentage of children where it would be possible to do without anticonvulsants I went through all admissions from 1988-89. During that time, we admitted a total of 155 children with cerebral seizures to the wards, 30 of them with febrile seizures. I will not consider these in detail, but we found that 5-10 drops of Belladonna Rh 6x given hourly proved very effective in their cases. It was generally possible to do without antipyretics, and we only used diazepam on one occasion to break a prolonged attack. 36 of the remaining 125 children were treated without anticonvulsants. I feel it is important to state this in order to avoid giving the impression that we are able to treat the majority of children with seizure disorders without anticonvulsants. Below, some groups of seizure disorders are considered in more detail.
We have treated 21 children with this type of condition on an inpatient basis in the last two years. 3 of the 21 had developed normally, which is in line with the general experience that only 10% of these children show normal development and the rest gave evidence of more or less severe brain damage. We were able to treat 11 without anticonvulsants; 6 became seizure-free; 2 showed improvement; and with 2 the seizures continued unchanged or grew worse. 5 of these children had been on anticonvulsants at another hospital and proved treatment-resistant. One of them became seizure-free initially but had a recurrence some months later and was successfully treated with valproate at another hospital. The mother had stopped the anthroposophical medicines a few weeks after we had been treating the child and had not come back for further treatment. Viscum proved particularly effective in treating children with infantile spasms. It is interesting to note that three of the children became seizure-free when they had febrile infections. In children in this group who have severe brain damage and corresponding developmental disorders, the spasms do not determine the degree of handicap to any major extent. This creates a time slot for anthroposophical treatment and was for us justification for extreme reserve in using ACTH with its serious side effects and up to 1% mortality. We prefer to use valproate when we decide on anticonvulsant treatment. With the 6 children treated without anticonvulsants, it was a week to some months before they were seizure-free.
Other seizure disorders with multifocal EEG changes
Seven children showed signs of multifocal increased tendency to develop seizures, with the types of seizures showing considerable variation clinically; 2 of these children had severe, progressive neurodegenerative conditions, and the others also showed signs of more or less severe brain damage; 3 presented predominantly with tonic-clone grand mal seizures with lateral emphasis; 1 child had laughing fits (a rare form of seizure). 3 of these children were resistant to anticonvulsant treatment; 5 showed improvement under treatment; 2 became seizure-free.
Benign focal seizures
Jacksonian or rolandic seizures are the most common form of focal seizure disorder in childhood, seen in about 10-15% of all cases. We had 8 children belonging to this group as inpatients. None showed signs of serious organic brain damage. 5 became seizure-free on treatment; 2 improved; 1 showed temporary improvement but later needed an anticonvulsant.
Grand mal epilepsy
We treated a total of 16 children with this condition without anticonvulsants. 4 showed primary and 9 secondary generalized EEG changes, 3 no definite EEG changes, and 1 the typical malignant multiform evolution of early childhood grand mal epilepsy. The mother of this child absolutely refused the use of anticonvulsants; when the child showed only inadequate improvement she took the child to a naturopath for further treatment. Nine of the others became seizure-free; 4 improved. One child could not be followed up; another later had anticonvulsants from a conventional physician. Three children had symptoms of severe organic brain damage; 3 had previously been on anticonvulsants and proved treatment-resistant.
Pyknolepsy or absence seizures
In this group, we have not so far seen appreciable improvement with anthroposophical treatment, whereas progress tends to be good on anticonvulsants. We therefore have not admitted the children with typical absence seizures as inpatients; they were treated by my colleague, Michael Meusers, in the children's psychiatric outpatient unit. I believe that with this form of seizure disorder it is a matter of trying breathing exercises at different levels, systematically and for an extended period. So far, it has not been possible to do this with the necessary intensity for the children treated as outpatients. They also tend to be school children and have major problems if they miss too much school. Most parents therefore want to have their child seizure-free as quickly as possible, using well-established methods. Absences may also occur with other seizure disorders. The case history of a child with Lennox syndrome and absences as a dominant symptom is given below.
Myoclonic epilepsy and drop attacks
Four children who came under this heading were treated without anticonvulsants; 2 who showed generalized EEG changes and purely myoclonic seizures were clinically seizure-free within a few months — the case history of one is given below. Another child had distinct myoclonic akinetic seizures clinically but no typical EEG changes. A sister of this child had been given anticonvulsants for a time to treat similar seizures. The child was normally developed, like the other two with myoclonic seizures, and became seizure-free in a few weeks. Another child had grand mal attacks at extended intervals as well as myoclonic seizures. Prior attempts with anticonvulsants had given no improvement, while the child's eczema had grown much worse. Anthroposophical treatment resulted in improvement, but the child did not become seizure-free.
The remaining children treated without anticonvulsants included two with complex partial seizures, one with Lennox syndrome, and others suffering mainly from severe brain damage with different kinds of seizures. It was not possible to classify them unequivocally.
Summing up, it is possible to say that 25 of the 54 children treated without anticonvulsants became seizure-free; 16 improved; 5 showed no change or deterioration; 2 could not be followed up; and 3 later had anticonvulsants. 25 of these children had severe brain damage, 20 showed normal development; 9 presented with mild to moderate developmental or partial performance deficits. These figures clearly cannot do justice to a pathological process with such varied symptomatology.
Essentially, one would need to give the history of every child. 5 case histories are given below. They may be said to be characteristic, giving some idea of the different kinds of outcome. For myself, the highly personal relationship to the patient and the parents, based on trust, played a special role in evolutions that proved distinctly successful.
J. W. d.o.b. 8 Aug. 1982
Diagnosis: Jacksonian epilepsy
The boy was admitted when he was just on 7 years old. He had had four relatively short seizures early that morning, during which he was unresponsive, eyes fixed; he was flaccid, with myoclonus at the right comer of the mouth. Family history not contributory. J. had not been seriously ill before. Occasional bedwetting. Neurological examination not contributory. Development appropriate for his age; a lively boy, fine-limbed, pale, a little precocious, nervy and restless. EEG showed left Centro-temporo-parietal solitary sharp-slow waves every few seconds, most likely to be a benign focal Jacksonian epilepsy. He was given 8 drops of Hyoscyamus Rh 3x t.i.d., a good pinch of Argentum 6x at night during the waxing moon, 6 drops of Phosphorus 6x in the morning during the waning moon, as his parents had noted that his behavior clearly related to the moon phases, with aggression. J. had four more relatively short seizures in the first month following his discharge. It was found that after a seizure he would choose black or dark colors when painting. No further seizures in the last 5 months. He developed a good appetite on exhibition of Gentianum 5%, with his whole metabolism seeming stronger. Follow-up to date 6 months.
P-M. K. d.o.b. 28 April 1981
Diagnosis: generalized seizure disorder with grand mal
P-M.K. is the second child in the family. His sibling was on anticonvulsants for frequent complicated febrile seizures. He was first admitted after two generalized clonic seizures during a febrile infection at age 9 months. Developed roseola infantum whilst on the ward, and was given 6 drops of Belladonna 6x t.i.d. Physical examination not contributory, also neurologically. Even then his constitution was strong, and more of the macrocephalic type. EEG when awake normal. A month later, he developed otitis media, with two further seizures. Cichorium 3x and Quartz 30x were added as longterm medication. P-M. was able to walk unaided at 16 months but did not yet talk. Anthroposophical medication was discontinued at 16 months. He wet himself again at 3 years, having been dry before. Hypericum rubs were prescribed. A further seizure developed when he had a temperature in May 1984 and again in February 1986. In April 1986, he had three tonic-clonic seizures, for the first time without having a temperature. At this time, it was found that the large, adipose boy tended to go all out physically, played a lot of football and was also allowed to watch television. He wet his bed again on several occasions. As the seizures were now occurring at play and there was a danger of P-M. getting seriously hurt, anticonvulsant treatment with Ergenyl (sodium valproate) was given for a short time and then stopped because of severe gastric symptoms. The parents did not want him to have other anticonvulsants, and this created the opportunity for continuing anthroposophical treatment, now with Quartz 2x, a good pinch t.i.d. and again Belladonna 6x, 6 drops t.i.d. It was also discussed that P-M. should watch little television from now on and not get too wild in his play, nor should he use up his physical energies for too long in the open air, with the whole day given a more rhythmic structure. With this treatment he had one further seizure after getting up one morning in June. A week later, he had a temperature for 5 days but did not have a seizure. The last seizure occurred when he had a temperature in December 1986. Since then P-M. has been seizure-free and is now receiving no more medication. It should also be mentioned that his sleep EEG showed changes concomitant with a primary generalized seizure disorder.
K. H., d.o.b. 15 May 1982
Diagnosis: brain damage in early childhood and Lennox syndrome seizures of an infant born prematurely in the 27th week.
K. was born in the 27th week of pregnancy weighing 900 g. His mother was Korean and a nurse, his father African. K. had to have artificial respiration for 2 months as a neonate. Development was seriously delayed in his first year, and he only learned to stand at 1-1/2 years. First tonic-clonic generalized seizure when he had a temperature at 2 years. EEG was said to have been pathological, and anticonvulsant treatment was given with valproate. No major attacks after this, but probably minor seizures even then, though his mother did not notice them. Reported not to have developed speech by then. EEG said to have been poor during the 1 1/2 years on valproate. K. was somnolent, and his mother therefore stopped the treatment of her own accord.
In January 1987, admitted to the children's ward for a few days; since then seen as an outpatient. K. seemed distinctly malnourished, his prematurity still apparent. Marked motor unrest with lack of concentration and serious sleep disorders. K. was hardly able to play meaningfully and was unable to express himself effectively in speech. Balance problem, motor skills about 2 years behind. EEG showed spike and poly spike wave complexes focally in left frontal area with secondary generalization. Up to April 1989 evolution relative to treatment for seizures not satisfactory. Parent refused to consider with smacking of lips, short-term myoclonus or also loss of muscle tone for some seconds. K. was making progress in his development, learning to say a few words effectively and go to the toilet by himself. He also seemed more biddable concerning his motor unrest than before. He was given Belladonna in different potencies, Hyoscyamus Rh 3x, Hypophysis 6x, Bryophyllum argento cultum Rh 3x. On the advice of a special teacher, his mother also began to give K. an Arnica bath three times a week in April. This resulted in drastic improvement, with K. only having short-term absences on rare occasions. His EEG was also much better, with only solitary spike waves in different leads.
My impression of K. was of a child whose astral body was only minimally involved in the body and not guided by the I, which came to expression in the driven nature of his organism. The simple measure of Arnica baths, with their effect on the neurosensory organization, calling the astral body into the living physical body, gave convincing and lasting improvement.
S. S., d.o.b. 1 Sept. 1985
Diagnosis: generalized seizure disorder with myoclonic seizures
S. had had a purulent sore throat 3 weeks prior to admission, and this had been treated with antibiotics. The parents noted short-term myoclonic seizures affecting the whole body at this time, sometimes at 4-minute intervals. An EEG taken in the outpatient unit showed generalized specific activity. S. had developed normally in her early years, and there was no family history of seizures. She had had no serious illnesses. The mother said she had felt greatly discontented in the weeks before admission, feeling she had been left alone because her husband was much engaged at work. She said she also cried a lot. S. had wet her pants again in the daytime, having been dry at night before. She had also said on several occasions that she had no mummy, and that daddy was her treasure, which worried her mother. On admission S. was found to be a lively toddler, physically and developmentally in accord with her age. The EEG again and again showed short groups of generalized spike waves with normal base activity. Treatment started with 5 drops of hyoscyamus Rh 3x q a.m., 5 drops of Belladonna Rh 30x q H.S., 5 drops of Viscum mali 5x t.i.d., copper oil medicated rubs applied to the arms, and 3 sulfur baths a week. Inpatient treatment was given for a week only, after which she attended outpatient. Progress was variable in the first weeks, and it was noted that S. reacted to relocation and a new environment with an aggravation of seizures. The mother seemed very anxious and unsure when she came with the child. For a time, the EEG showed status epilepticus type changes, with symmetric myoclonus up to 20 times an hour mainly in the upper extremities. The child's general condition did not seem to be much affected, however. At home her bed was moved to a new position following the advice of a buildings biologist. General treatment was effectively supported by a consultation with Dr. Gerretsen at the Ita Wegman Clinic, which had been at the mother's request. Rose oil medicated rubs were prescribed in addition, with Agaricus muscarius 12x given by mouth. From the third month after starting treatment there was progressive improvement until the child was finally seizure-free. Her mother gradually stopped her medication in the months that followed; there were no further seizures, and she was entirely satisfied with S.'s development. The EEG was also found to be normal on several follow-up examinations. Follow-up since seizures stopped has been 18 months.
K. H., d.o.b. 12 Dec. 1987
Diagnosis: congenital hemiatrophy of right cerebral hemisphere with megaventricle on right, cerebral seizure disorder of infantile spasm type.
K. was delivered by caesarean section because of his mother's EPH gestosis and premature rupture of the membranes. Dystrophy was diagnosed at a birth weight of 1,880 g, with hemiatrophy of the right cerebral hemisphere diagnosed at the neonatal stage. Apneic spells were noted at home at age 2 months, when a monitor was already in use. A little later, the parents observed sudden backward movements of the arms, sometimes also myoclonic propulsive movements occurring 5-6 times within 30 seconds. The EEG showed continuous hypsarrhythmia interspersed with sharp and steep waves (Prof. Bechinger, Ulm University Hospital). Phenobarbital was prescribed, and when there was no improvement, finally a course of ACTH at age 3 months. The dose was increased to 100 u./die. The EEG slowly improved, as did the seizures, which finally ceased, but cardiomyopathy developed; liver tests showed increased values, and the blood pressure rose to 170/100 mmHg. The ACTH dose was rapidly reduced, with treatment stopped within a week. In the months that followed, with phenobarbital continued, there were no further seizures, though the EEG showed signs of incipient hemihypsarrhythmia on the right. At 9 months, recurrence of infantile spasms. EEG showed hemihypsarrhythmia and generalized potentials. At 13 months, progressive deterioration, with grand mal and tonic adversive seizures, myoclonic seizures and frequent apnea. At times, seizures would come several times in a series of up to 10 minutes' duration. Admission on 10 April 1989. On admission a distinctly microcephalic child, barely making contact, little reaction to stimuli, unable to sit in a stable way, short-term flexion and extension when stood up with support, no crawling, prehension beginning to be possible on the right. Body build appeared to lack form. EEG highly pathological with multifocal specific activity as spike and sharp slow waves, stretches of typical fully-developed hypsarrhythmia.
Treatment. Phenobarbital initially continued (22.5 mg/die), plus a good pinch of Strychnine 12x at night (started previously by a homeopathic colleague), 10 drops of Arnica Rh 30x q a.m., 8 drops of Belladonna Rh 10x t.i.d., Sulfur baths 3 times a week, and medicated rubs with Equisetum oil. During the first 10 days of treatment, the child had up to 10 seizures a day. Strychnine was discontinued, with 5 drops of Viscum mali 5x q H.S. given in addition. Remarkably this resulted in freedom from seizures and the EEG returning to normal within a week. Phenobarbital could then be discontinued within a short time, and K. has had no further attacks to this day. The parents report development to be good, within the limits set by the existing brain damage. Apart from Viscum, K. was later also given a good pinch of Quartz 6x t.i.d. Follow-up 10 months to date.
Rene Madeleyn, MD
Im Haberschlai 7
1. Steiner R. Curative Education (GA 317) June and July 1924. Tr. M. Adams. London: Rudolf Steiner Press 1981.
2. Steiner R. Spiritual Relations in the Configuration of the Human Organism (in GA 218) lecture of 22 Oct. 1922. Tr. M. Deussen. Revised ed. Spring Valley: Mercury Press 1984.
3. Steiner R. Health and Illness vols. 1 and 2 (in GA 348). Tr. M. St Goar. New York: Anthroposophic Press 1981 & 1983.
4. Steiner R. At the Gates of Spiritual Science (GA 95). Tr. E. Goddard, C. Davy. London: Rudolf Steiner Press 1986.
5. Steiner R, Wegman I. Extending Practical Medicine (GA 27). Tr. A. Meuss. London: Rudolf Steiner Press 1996.
6. Walter G. LTber die kindliche Epilepsie. Beitr Env Heilk 1956 Nr. 1.
7. Konig K. Versuche einer geisteswissenschaftlichen Theorie der im Elektroenzephalogramm erscheinenden PhAnomene. Beitr Env Heilk 1954. Nr. 1.
8. Holtzapfel W. Die Dreigliederung der kleinen epileptischen AnfAlle. Beitr Env Heilk 1959 Nr. 2.
9. von Zabem B. Eine Polaritit in der epileptischen Konstitution. Beitr Ent) Heilk 1965 Nr. 3.
10. Muller-Gutke W, Giesler E. Zur Kasuistik der KrampfanfAlle. Beitr Er7o Heilk 1955 Nr. 3 and 1956 Nr. 4.
11. Vogel HH. Die Behandlung eines Patienten mit symptomatischer Epilepsie. Beitr Eno Heilk 1953 Nr. 3.
12. Treichler R. Vora Wesen der Epilepsie. Stuttgart 1979.
13. Konig K. Epilepsie und Hysterie. Arlesheim 1978.
14. Steiner R. Tlw Spiritual-Scientific Aspect of Therapy (GA 313). Tr. R. Mansell. Long Beach CA: Rudolf Steiner Research Foundation 1990.
15. Steiner R. Spiritual Science and Medicine (GA 312). Tr. not known. London: Rudolf Steiner Press 1975.
16. Walter H. Abnormitaten der geistig-seelischen Entwicklung in ihren Krankheitserscheinungen und deren Behandlungsm6glichkeiten. Private publication by Institute of Clinical Medicine in Arlesheim 1955.
17. Degenaar AG. Krankheitsfalle und andere medizinische Fragen besprochen mit Rudolf Steiner. Private publication.
18. Steiner R. The Driving Force of Spiritual Powers in World History (GA 222). Tr. D. Osmond, J. Collis. Toronto: Steiner Book Centre 1972.
19. Steiner R. Eight Lectures to Doctors (in GA 316). Domach, 2-9 Jan. 1924. Tr. not known. MS translation R 96 at Rudolf Steiner House Library, London; or Steiner R. Course for Young Doctors (GA 316). Revised by G. Kamow. Spring Valley: Mercury Press 1994.
20. Madaus. Lchrbuch der biologischen Heilmittel. Hildesheim 1979.
21. Steiner R. Hygiene - A Social Problem. Dornach 7 April 1920 (in GA 314). Tr. not known. In Anthroposophicid Quarterly No. 3, 1927; or Fundamentals of Anthroposophical Medicine (in GA 314). Stuttgart, 26, 27 (2 lectures) and 28 Oct. 1922. Tr. A. Wulsin. Spring Valley NY: Mercury 1986 or Three Lectures to Doctors (in GA 314). Dornach, 31 Dec. 1923, 1 & 2 Jan. 1924. Tr. R. Mansell. Long Beach CA: Rudolf Steiner Research Foundation 1990 or Physiology and Therapeutics (in GA 314). Domach, 7,8 and 9 (2 lectures) Oct. 1920. Tr. A. Wulsin, G. Karnow. Spring Valley NY: Mercury 1986; or Medical Discussions (in GA 314). Domach, 21-23 April 1924. Tr. not known. MS translation R92 in Rudolf Steiner House Library, London.
22. Steiner R. Universe, Earth and Man (GA 105). Tr. not known. New York: Anthroposophic Press 1985.