Rubrics – As an “Index” to Clinical Medicine

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rubricAbstract: Understating the rubrics does not just perceive the literal meaning of the symptoms but should be a logical correlation of the Symptoms with that of Clinical Medicine.

 

A Repertory is the Index of symptoms from the Proving. The Repertory’s author describes these symptoms and puts them in a particular format depending on the Logic and/or Philosophy the author follows, for example Boenninghausen or Kent. We are also trained to handle those Repertorial Rubrics pursuing the same Logic or Philosophy.

 

Since Repertory is the only source of information about the Relative value of symptoms of a medicine from that of proving it should be understood even beyond the underlying Logic or Philosophy. That is many rubrics are not explored in their original value since now. So it is the time to review our-self the Repertorial Rubrics to find their newer dimensions.

 

In such an inquiry we can notice that many Rubrics are accurately indicating the Clinical Presentations of Various Diseases and even their Modern Classification. Now it is in our hands to interpret Rubrics with that of Clinical Medicine. Here I am quoting some interesting rubrics as examples and how they become an “Index” to Clinical Medicine.

 

We all know Seizure is a paroxysmal event due to abnormal, excessive, hypersynchronous discharges from an aggregate of central nervous system neurons. Depending on the distribution of discharges, this abnormal activity can have various manifestations, ranging from dramatic convulsive activity to experiential phenomena not readily discernible by an observer. Based on clinical presentations seizures can be classified into various types. Now we can see how the seizure and its types are represented as Rubrics using Synthesis Repertory 9.0.

 

Common Seizure Presentations

 

S.No Rubrics from Synthesis Repertory Type of seizure Explanation
·  Generals, convulsions, children, in

·  Mind, unconsciousness, frequent spells of unconsciousness

·  Mind, absent minded, epileptic attack before

·  Mind, absent minded, periodical, short lasting attacks of absentmindedness

·  Mind, absent minded, dreamy

·  Generals, convulsions, sudden

·  Generals, convulsions, consciousness, without

·  Generals, convulsions, short attacks

·  Generals, convulsions, epileptic, aura, face, chewing motion

·  Face, chewing motion of the jaw, epilepsy, before an attack of

·  Eye, twitching, lids, epileptic convulsions, before

·  Extremities, convulsions, hand

·  Extremities, convulsions, hand, clonic

·  Generals, convulsions, epileptic, aura, hands, in

·  Generals, convulsions, begin in, hands

·  Extremities, jerking, fingers, epilepsy

·  Head, motions of head, convulsive

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Absence seizure / Petit Mal seizure

 

 

 

 

Usually begin in childhood or early adolescence.

Characterized by sudden, brief lapses of consciousness

Accompanied by subtle, bilateral motor signs such as rapid blinking of the eyelids, chewing movements, or small-amplitude, clonic movements of the hands.

Since the clinical signs of the seizures are subtle, the first clue to absence epilepsy is often unexplained “daydreaming”

 

·  Generals, convulsions, epileptic

·  Generals, convulsions, sudden

·  Generals, convulsions, tonic

·  Face, convulsions, spasms, muscles

·  Face, convulsions, spasms, masseter muscles

·  Face, convulsions, spasms, jaw

·  Mouth, biting, tongue, convulsions, during

·  Generals, convulsions, epileptic, during epileptic convulsions, complaints, larynx, spasms in

·  Generals, convulsions, cyanosis, with

·  Cough, convulsions, with, larynx in

·  Respiration, arrested, convulsion, during

·  Respiration, difficult, convulsion, during

·  Respiration, rattling, convulsion, during

·  Mouth, mucus, ropy, epileptic convulsions, during

·  Mouth, salivation, convulsions, with

·  Mouth, spasms, accompanied by, froth

·  Throat, gurgling, esophagus  is, convulsion, during

·  Mind, shrieking, convulsions

·  Mind, moaning, convulsion, in

·  Mouth, biting, tongue, convulsions, during

·  Generals, convulsions, epileptic, during, epileptic complaints, palpitation, irregular

·  Generals, pulse, frequent, convulsions, during

·  Generals, convulsions, epileptic, during, epileptic convulsions, complaints, pupils, dilated

·  Generals, convulsions, epileptic, after, epileptic convulsions, complaints, unconsciousness

·  Generals, convulsions, epileptic, after, epileptic convulsions, complaints, headache

·  Generals, convulsions, epileptic, after, epileptic convulsions, complaints, prostration

·  Generals, convulsions, urination, involuntary

Rectum, involuntary stool, convulsion, during

 

 

 

 

 

 

 

 

 

 

 

 

Generalized, Tonic – Clonic Seizures / Grand Mal seizure

 

 

 

Usually begins abruptly without warning.

The initial phase of the seizure is usually tonic contraction of muscles throughout the body, accounting for a number of the classic features of the event.

Tonic contraction of the muscles of expiration and the larynx at the onset will produce a loud moan or “ictal cry.” Respirations are impaired, secretions pool in the oropharynx, and cyanosis develops.

Contraction of the jaw muscles may cause biting of the tongue.

A marked enhancement of sympathetic tone leads to increases in heart rate, blood pressure, and pupillary size.

After 10–20 s, the tonic phase of the seizure typically evolves into the clonic phase, produced by the superimposition of periods of muscle relaxation on the tonic muscle contraction.

The periods of relaxation progressively increase until the end of the ictal phase, which usually lasts no more than 1 min.

The postictal phase is characterized by unresponsiveness, muscular flaccidity, and excessive salivation that can cause stridorous breathing and partial airway obstruction.

Bladder or bowel incontinence may occur at this point.

 

Specific Seizure Presentations

S.No Rubrics from Synthesis Repertory Type of seizure Explanation
1. Generals, convulsions, alternating with, relaxation of muscular system  

Akinetic / Atonic seizure

 

Consists of a brief lapse in muscle tone

2. ·   Generals, convulsions, noise, from

·   Generals, convulsions, epileptic, aura, ear noises

·   Generals, convulsions, epileptic, aura, auditory complaints

 

 

Audiogenic seizure / Startle seizure

 

 

Precipitated by loud / sudden noises

3. ·  Generals, convulsions, epileptic, during epileptic convulsions, complaints, heart, complaints of the

·  Generals, convulsions, epileptic, during epileptic convulsions, complaints, palpitation, irregular

·  Chest, congestion, heart, convulsions, in

 

 

Autonomic seizure

 

 

Characterized by objectively documented dysfunction of the autonomic nervous system, usually involving cardiovascular system.

4. ·  Generals, convulsions, clonic

·  Generals, jerking, convulsions, as in

 

Clonic seizure

Characterized by repetitive rhythmic jerking of all or part of the body
5. ·   Generals, convulsions, touched, when

·   Generals, convulsions, brilliant objects, from

·   Generals, convulsions, epileptic, aura, visual complaints

 

Complex precipitated seizure / Sensory precipitated seizure / Reflex seizure

 

 

Reflux initiated by specialized sensory stimuli or certain visual pattern.

6. ·   Mind, fear, convulsions, with

·   Mind, excitement, convulsions, with

·   Mind, dream, as if in a, convulsions, after

 

Complex partial temporal lobe seizure

 

Intense pleasure or fear ushering in the attack; sense of loss of personal or environmental reality

7. ·  Generals, convulsions, clonic alternating with tonic

·  Generals, convulsions, tonic

 

Convulsive seizure

 

With clonic or tonic-clonic motor activity

8. Generals, convulsions, injuries from, head of the Early post traumatic seizure Due to cranio-cerebral trauma
9. Generals, convulsions, epileptic Epileptic seizure Seizure caused by epilepsy
10. Generals, convulsions, heat (fever), during the  

Febrile seizure

 

Associated with fever

11. ·  Face, convulsions, spasms

·  Mouth, convulsions

·  Chest, convulsion

·  Back, convulsions

·  Extremities, convulsions

·  Extremities, convulsions, single parts

·  Extremities, convulsions, tonic, single parts

 

 

 

 

Focal motor seizure

 

 

 

 

Simple partial seizure with localized motor activity

12. ·  Mind, laughing, epileptic convulsion

·  Mind, laughing, sardonic, epileptic convulsion, during

·  Generals, convulsions, laughing, from

 

 

Gelastic seizure

 

Characterized by bursts of involuntary laughter or giggling

13. ·  Generals, convulsions, isolated groups of muscles, of

·  Face, convulsions, spasms, extending to, limbs

·  Extremities, convulsion, lower limbs, extending to, upper limbs

·  Extremities, convulsion, foot, extending to, knees

·  Generals, convulsions, begin in below, extending to upwards

·  Generals, convulsions, begin in center, extending to circumference

·  Generals, convulsions, epileptic, aura, hands in, extending to body

·  Generals, convulsions, epileptic, aura, solar plexus from, extending to, chest

 

 

 

 

 

 

 

 

Jacksonian seizure

 

 

 

 

 

 

 

Motor seizure that initially involves one part of the body and then progressively spreads to other parts of the body

14. Generals, convulsions, cough, after Laryngeal seizure Precipitated by coughing
·   Generals, convulsions, tonic, single parts

·   Generals, convulsions, isolated groups of muscles, of

 

Myoclonic seizure

 

Sudden contractions of muscle fibers, muscles, or groups of muscles

16. Generals, convulsions, night Nocturnal seizure Only at night
17. Generals, convulsions, epileptiform Nonepileptic seizure Any behavior that resembles a seizure, but is not epileptic
18. ·   Vision, loss of vision, convulsion, after

·   Vision, loss of vision, convulsion, before

·   Vision, diplopia, convulsions, with

 

 

Occipital lobe seizure

 

Originate from occipital lobe resulting in visual abnormalities

19. ·   Generals, convulsions, bright light, from

·   Generals, convulsions, shining objects from, mirror; reflected light from water

 

Photogenic seizure / Pattern sensitive seizure

 

 

Reflux initiated by light

20. ·   Generals, convulsions, begin in, abdomen

·   Generals, convulsions, begin in, arm

·   Generals, convulsions, begin in, back

·   Generals, convulsions, begin in, calf muscles, of

·   Generals, convulsions, begin in, extremities

·   Generals, convulsions, begin in, eye

·   Generals, convulsions, begin in, face

·   Generals, convulsions, begin in, fingers

·   Generals, convulsions, begin in, hands

·   Generals, convulsions, begin in, head

·   Generals, convulsions, begin in, legs

·   Generals, convulsions, begin in, throat

·   Generals, convulsions, begin in, toes

 

 

 

 

 

 

 

 

 

Primary generalized seizure

 

 

 

 

 

 

 

 

 

Begin as partial seizures then spread diffusely throughout the cortex

21. ·   Generals, convulsions, runs before convulsions

·   Generals, convulsions, motion, aggravation

 

Procursive seizure

 

Initiated by running or whirling

22. Generals, convulsions, hysterical Psyogenic seizure Resembles an epileptic seizure, but is related to psychiatric disturbance
23. Generals, convulsions, epileptic, psycomotor seizures Psycomotor seizure Characterized by psychic manifestation
24. Generals, convulsions, one side, accompanied by, speech, wanting Rolandic epilepsy With arrest of speech and muscular contractions of the side of face and arm
25. ·   Head, drawn, backward, convulsion, in

·   Head, turned, left in, convulsions, to

·   Eye, turned, convulsions, during

·   Eye, turned, downward,  convulsions, during

·   Eye, turned, upward,  convulsions, during

·   Generals, convulsions, epileptic, during epileptic convulsions, complaints, eyes, downwards, turned

·   Generals, convulsions, epileptic, during epileptic convulsions, complaints, eyes, upwards to right, turned

·   Generals, convulsions, epileptic, during epileptic convulsions, complaints, eyes, wrinkling of eyes

·   Extremities, convulsions, foot

·   Extremities, convulsions, foot, tonic

·   Generals, paralysis, one side, convulsions, after

 

 

 

 

 

 

 

 

Simple partial motor seizure

 

 

 

 

 

Focal motor symptom correlates with the area of their representation in the motor cortex.

Examples:

Rotation of head and eyes contra-laterally; tonic foot movements ipsi- laterally; etc.,

 

26. Extremities, numbness, leg, convulsion, before Simple partial sensory seizure Emanating from the sensory cortex
27. ·   Generals, convulsions, touched when

·   Generals, convulsions, touched when, slight touch

 

Sensory seizure

 

Initiated by a somato-sensory phenomenon

28. ·   Generals, convulsions, sleeplessness, with or after

·   Generals, convulsions, epileptic, aura, sleeplessness

 

Somnabulic seizure

 

Post-ictal automatism in which the patient runs or walks

29. ·   Generals, convulsions, tonic

·   Generals, convulsions, tetanic rigidity

 

Tonic seizure

Characterized by a sustained increase in muscle tone
30. ·   Generals, convulsions, epileptic, aura (before epileptic convulsions)

·   Generals, convulsions, epileptic, aura, vertigo

 

Torando Seizure

 

With an aura of severe vertigo or a feeling of being drawn up into space

31. ·   Eye, turned, convulsions, during

·   Head, drawn backwards, convulsions, in

 

Versive seizure

 

Characterized by sustained, forced conjugate ocular and cephalic deviation

32. ·  Generals, convulsions, vomiting, during

·  Generals, convulsions, diarrhea, with

 

Visceral seizure

Due to visceral response to a focal irritation in cerebral cortex manifested with vomiting and / or Diarrhoea

Conclusion

Repertory is a multifaceted tool which can be explored and utilized successfully under versatile vistas. One such panoramic view is explained above with few examples.

“Rubrics are not just Symptom Complex but

Rubrics are the Index to Clinical Medicine”

References:

  1. Dennis L.Kasper, Eugene Braunwald, Anthony S.Fauci, Stephen L.Hauser, Dan L.Longo, J.Larry, Harrison’s Principles of Internal Medicine, Seventeenth Edition, Volume-2, The McGraw-Hill Companies, Inc., Chapter 363.
  2. David A. Warrell, Timothy M. Cox, John D. Firth, Edward J., J R., M.D. Benz, Oxford Textbook of Medicine, 4th edition, Oxford Press, Chapter 24.13.3.
  3. http://www.medilexicon.com/medicaldictionary.php
  4. http://en.wikipedia.org/wiki/Seizure_types
  5. Stedman’s Medical Dictionary, Lippincott Williams & Wilkins, 28th Edition, 2006.
  6. Frederik Schroyens, Synthesis Repertory 9.0, Homeopathic Book Publishers, 2002.

 

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About Author

Dr H.Venkatesan., BHMS, MD (Hom) Practice of Medicine is Lecturer, Dept. of Practice of Medicine, Vinayaka Mission’s Homoeopathic Medical College & Hospital, Salem, Tamil Nadu.

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