A case of developmental delay and epilepsy

Sarah is a 14-year-old girl first seen in June 2011. The parents' main concern was the onset of brief, epilptic absence seizures lasting 15-30 seconds over the past two to three years. An EEG was negative. Then recently she was sent to summer camp, cried the whole time while there and upon her return started to experience full blown grand mal seizures, which are becoming more frequent, averaging about eight grand mal seizures every two weeks.

She has been home schooled since September 2010.

Epileptic Seizures

Sarah gets dizzy before a seizure and becomes very loud, can't control her voice, becomes overly social, saying hi to everyone. After a seizure she is sick to her stomach with vomiting and very weak, pale and lifeless for up to two days.

I noticed that she bites her finger nails severely and asked if she also bites her toe nails.

"Yes, she does and always from birth she has needed something to suck on. She had a soother until age 4-5, after that, still everything went into her mouth."

She was covered in vernix caseosa at birth.

At 1.5 years old she had white stools and was taken to emergency, apparently she was suffering from anemia. The family was advised to give her molasses in milk which helped.

Pervasive Developmental Disorder

She has a global developental delay. Did not sit up until 15 months old, did not walk until three years old, no real speech until grade three, only gave one-word answers. In grade four-five she started putting two-three words together. Teething has also been slow, she still has some baby teeth now and did not begin to lose baby teeth until grade three or fours.

Her bowels became constipated as soon as solids were introduced. She could actually not even eat solids until she was one year old, could not even manage apple sauce, was entirely breast fed and would nurse for hours and hours at a time, she had such an intense need for sucking.

Then the constipation became very serious when she started Kindergarten at age four to five. The stools were very large and hard, she would scream in pain and had to be relieved with fleet enemas. She was better with lots of pureed veggies and worse on a lot of breads.

History of Biting and Chewing

Sarah has a history of tantrums in grade one, two and three, including biting. She would bite her younger siblings and especially her mother and be otherwise aggressive.

She would put anything into her mouth, chew on bags, pennies, even had a quarter stuck in her throat once.

She loves to imitate people and kept repeating things I said to her in the consultation. It is both funny and annoying.

She loves music and singing.

She needs a fan on during sleep, the sound soothes her.

She has an amazing memory for people's names, even if she has only met them once.

She sleeps with her arms above her head.

She is very cheerful and quite loud in general. She felt anxious in school and is now being home schooled.

Sarah also has eczema around her mouth, in her ears and in her armpits.

She has a history of ear infections and is allergic to penicillin.

She also has a history of bladder infections, usually around Christmas.

She has a fear of new things and situations and gets really nervous with anticipation.

She appears as if she is suffering from a chromosomal defect, with small ears and fingers, but she has been tested and is genetically normal.

Assessment:

A young girl with pervasive developmental delay, appearing more like a 6-7 year-old child than a 14 year-old with increasingly frequent grand mal epileptic seizures.

What was remarkable about this girl was her love of music and singing, the tendency to repeat everything other people said, also know as echolalia and the strong history of sucking and biting, one could say, an oral fixation. In fact, it was this remarkably strong feature to bite, put everything in her mouth and even bite her toenails which led me to prescribe Medorrhinum, a homeopathic remedy made from the gonorrhea bacterium.

The tendency to bladder infections and the apparent genetic disorder without a chromosomal abnormality, as well as her sleeping position furhter pointed to this remedy.

For the first week, however, I just prescribed a high dose of fish oil, which led to a remarkable improvement in her skin. The parents also reported that Sarah seemed to be more alert. Then I started her on Medorrhinum 30 CH a few drops twice a day.

Follow up after two weeks:

For 4-5 days after starting the remedy Sarah had 1-2 soft bowel movements a day which was amzing to the mother. Her eczema flared up and then improved, her skin looks much better. An intial aggravation, or rather, healing response like that with increased elimination is always a good sign, especially since Sarah has had bowel troubles almost all of her life.

She has only had four seizures in two weeks which is 50% less. Overall she is much quieter and calmer. In fact, the parents can't believe the difference. "The house is quiet, it's a huge change. It is peaceful, it's never been like this!"

She has been sleeping better, before she would wake at 4:30 - 5 am and be up, now she sleeps until 6:30 - 7 am. She is not repeating everything that people are saying any more. She wants more to do, wants more mental stimulation. Her tutor said that her printing has dramatically improved. She is not quite as orally fixated but still puts lots of things in her mouth.

A different Child

She is like a different child in my office. Before she was very restless, repeating everything, interrupting constantly and speaking very loudly. During this visit she is completely calm and relaxed, a remarkable change.

"We are so happy, we can't believe it," the mother says.

I am hoping that not only her epilepsy will be controlled but that her development also accelerates. It would have been good to see her when she was much younger, but there is still much to be gained.

I will post updates on Sarah's progress regularly. In a case like this, treatment should be continued for several years, with office visits every two to three months to adjust the homeopathic remedies. I am very optimistic about Sarah's prognosis.

Follow-up August 16, 2011, six weeks after the last visit:

She had no seizures at all until last weekend, when she had four grand mal seizures and several absence seizures in two days. The mother reports that Sarah has not been taking her remedy as much over the past two weeks or so as the house is under renovation.

She has made very good progress academically, the school had told the family that Sarah would never print and she is printing now! The tutor said that Sarah had far exceeded her expectations for the summer.

She is still sleeping longer in the morning which is much appreciated by the mother. She sleeps on her side more now, less on the back with her hands above her head.

Her eczema is much better, but I noticed that she has cradle cap and apparently has had this since an infant. She will likely require Calcarea carbonicum in the future to clear this.

She is chewing on her hands the whole time during the consultation, is loud and unfocused again. This has been the case for the past week or so as well, it goes along with the seizures.

Seizures better, Behaviour worse

She is spitting at her mother during the consultation and I asked if she has been doing this before. The mother reports that Sarah has been much more difficult behaviourally over the past three weeks or so, less co-operative, more aggressive and even having some tantrums and breaking things.

I explain to her that this is a good development from my point of view. As the seizures are improving the previous issues will come back, including the former aggressive behaviour. I expect this to pass after some time.

Assessment:

Excellent response, seizure free for over six weeks in total, seizures returned over the past weekend while not taking the remedy consistently. Impressive gains academically with ability to print, which is new and which she could not do before the remedy.

Plan:

Medorrhimun 200CH in water once a day. Follow up in one month.

Follow-up September 21, 2011

Sarah has had no seizures at all! Her printing is going really well.

However, her behaviour has been 'brutal' according to the mother. If she is denied anything that she wants she gets very angry, blows her top and spits, hits and pinches people. She has been more obstinate, saying 'I'd doing what I'm doing', getting into the car and refusing to get back out, being very persistent in asking for things etc.

She is also suddenly burping and passing gas a lot more.

The chewing is terrible, everything goes into her mouth. Her cradle cap is unchanged.

Assessment:

She has had no seizures but the behaviour was not changing, even after increasing the dose of medorrhinum, so I decided to change her remedy.

Plan:

Calcarea-carbonica 30CH, once a day.

Follow-up: November 3, 2011

A few days after starting the calcarea Sarah had a seizure. Then over the past two weeks or so she has had one after another. I told the mother she should have called me immediately when Sarah re-experienced seizures.

Her behaviour has been amazing, she is still doing well with her printing, writing and spelling. Her eczema is very good - but it had already cleared with the medorrhinum.

Assessment:

Calcarea is not the correct remedy, Sarah is having seizures again. Her behaviour is better, but the seizures are back. We need a remedy that has the seizures, developmental delay, the chewing, the obstinacy, the biting and cradle cap.

Plan: Tuberculinum 30CH once  day.

Follow-up November 20, 2011:

I saw the mother in a coffee shop on November 20 and she reported that Sarah is doing very well, no seizures. Her behaviourhad been worse for a few days after starting the tuberculinum but has since settled down. Sarah wants to go back to school instead of being home-schooled. The mother is very happy.