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The
New England Journal of Homeopathy
Spring/Summer 1998, Vol.7 No.1
Myalgic Encephalitis
by Todd Hoover MD
In April of 1997, I made my first housecall in about 5 years to see a 59 year old woman who was unable to travel. She had been essentially housebound due to her illness for years, and this is the story she told. About twenty years ago, in England, she developed an acute flu like illness. Sharp intestinal pain (2) and fatigue (3) followed by chills and drenching sweats (2) came on over a 5 day period. She developed photophobia, and difficulty finding words. It became increasingly difficult to move "as if she was run over by a truck". Her body seemed very heavy(2).
She subsequently developed Erythema Nodosum with approximately 18 nodules on both lower legs. They were dark red and very painful nodules that eventually disappeared. Evaluation at that time was negative. The chills, sweats, photophobia, stabbing headaches in the temples, and extreme fatigue persisted intermittently until the present time.
For the past several years she has settled into a fairly severe pattern. She is confined to the house and much of the time, to bed, due to extreme weakness(3). Periodic worsenings include progressive heaviness of the body, especially the extremities. Arms are too tired to lift. Sleeping up to 23 hours per day requiring assistance to eat and go to the bathroom. Sleep is heavy with stertorous breathing. Waking due to headaches(2). Severe headaches, one sided and associated with nausea and vomiting. Headache is preceded by hunger and difficulty concentrating. Headaches are also particularly worse from using computer screens and overwork. Photophobia worsens (3) and she develops sensitivity to noise and voices (2).
During the heavy sleep episodes, she reports being partially awake and startling at reflecting objects. She gets vertigo, general incoordination, clumsiness and illegible writing. Concentration is cloudy and there are generally less thoughts(2).
She develops pain in joints (2) and muscles. Stiffness extends distally and there is frequently sciatica extending to right calf.
There is frequently a dry cough as well as dry eyes and mouth. Thirst is increased (3) for up to 160 oz/day. She has increased urination and diarrhea up to 6x per day. She is only able to eat small amounts of bland food.
Generally she is chilly, she becomes much worse from bathing (3). She is sensitive to jar(2).
Review of systems shows a desire for tropical/refreshing fruits, olive oil and brown rice. She is averse animal fats and butter. She is aggravated by dairy products. She develops dryness of the skin with any pressure on the back, and there is a history of a mask like rash on the face which was treated with steroids. Only other symptom of note is that the headaches seemed to present after the removal of the ovaries years ago.
Past medical history
reveals pertussis 2yo, viral encephalitis 4yo, fracture of skull 6yo,fracture
both arms 8yo, bronchitis and pneumonia teens, viral hepatitis 19 yo,
fracture 4 vertabrae 35 yo, onset of present illness 40 yo. She has 2
grown children and is currently separated from second husband. At the
time of onset of the illness she was married to first husband, raising
2 children, studying for a Ph.D., and doing volunteer work
for kids with drug dependency.
She has a fear of heights and of becoming poor She misses most the social interaction and has a strong desire to help others (3). She always tries to stay optimistic, but despairs that she will never be able to accomplish her life goals.
My impression of this woman is that she is physically weak, but mentally clear and bright. Her voice is tremulous at times. She is quite likable and straight forward.
Medications include
Flexoril, estrogen, progesterone, Depakote, beta
blocker, NSAID and codeine as needed.
Analysis: Chronic Fatigue Immunodeficiency Syndrome/Myalgic Encephalitis. Diagnostically the case fits the Center for Disease Control criteria for Chronic Fatigue Immunodeficiency, also known as Myalgic Encephalitis or Icelandic Disease.
An initial flu like syndrome followed by twenty years of cyclical severe fatigue and myalgias. It is as if the nervous system progressively shuts down and closes off completely into a vegetative, near comatose state. She then progressively cycles out of this state and becomes externally hypersensitive. Of interest, it is the headache that seems to rouse her from the stupor. In addition, there are heavy overtones of discontent and a tendency to overwork. Homeopathically, several features of this case stand out and must be prescribed upon. By choosing separate, distinct, and strongly expressed features of the case, you can maximize the likelihood of choosing a correct remedy.
Symptoms evaluated include:
1. Neurasthenia. Clearly there is severe fatigue and weakness on the level of the nervous system. It is as though the brain became inflamed and overpowering weakness resulted. Weakness is physical and especially mental. I see very little evidence of overlying depression, short of the frustration she experiences due to the extreme fatigue. You might use rubrics of lassitude, weariness, overpowering sleepiness, sleep, comatose, stupefaction or a combination of these. After considerable thought and changing rubrics, I settled upon an extraction from Reference Works under the search of Neurasthenia because I felt it most accurately reflected her condition.
2. Headache, one sided This symptom has the quality of being consistent, not common to the syndrome of CFIDS, and inter-related to the chief complaint of neurasthenia. The headache actually seems to pull the patient out of her comatose sleep. The most consistent and dramatic aspect of the headache was the one sided nature.
3. Heaviness, internally. This idea may be seen as part of the Neurasthenia. I decided to look at it separately, but placed less emphasis on the symptom. The patient more clearly distinguished this symptom as a separate issue from the sleepiness.
4. Awkwardness. Again this is a result of the nervous system weakness. This idea is represented by a combination of rubrics: Inability for writing, awkwardness of extremities, awkwardness lower extremities, stumbling, extremities: incoordination. This particular symptom is also very distressing to the patient.
5. Vision, exertion of, aggravates. While not a large symptom, I did look at this particular symptom to help narrow down the field of remedies. It is important because of its consistency and because it precedes the fatigue as a modality. You might combine with mental exertion aggravates.
6. Bathing, aggravates.
Although this symptom is also a modality, I was unclear of the exact meaning
of the symptom. I was unclear if the aggravation was due to the bathing
or the physical exertion of the bathing. Probably it related to the physical
exertion and therefore would be of less value as this is a very common
symptom in CFIDS. I looked at this symptom, but not
as a major factor.
By combining Rubrics
1 through 5, there are only 47 remedies that come through all rubrics.
Of these, the ones that have a strong predilection for the Nervous System
and weakness include: Agaricus, Alumina, Asarum, Cannabis indica, Causticum,
Cuprum metallicum, Magnesium carbonica, Natrum muriaticum, Natrum silicata,
Nux moschata, Nux vomica, Onosmodium, Phosphoric acid, Phosphorus, Silicea
and
Zincum metallicum.
Looking further at small remedies with only 4 rubrics of 5 we see: Alumina phosphorica, Alumina silicata, Cicuta virosa, Gelsemium, Moschus, Picric acid, Selenium, Valerian and Zincum phosphoricum all come into consideration.
In this case, although the patient did have diarrhea, it seemed to almost be a result of the weakness and not a cause. By eliminating remedies with a strong tendency toward spasm/seizure and remedies that tended to get weak due to grief or fluid loss, I was left with a smaller group: Alumina, Asarum, Cannabis indica, Nux-moschata, Onosmodium, Gelsemium, Moschus and Picric acidum.
Prescription: Onosmodium 1M
Onosmodium virginianum is False Gromwell. Boericke describes it as having "Want of power of concentration and coordination. Vertigo, numbness, and muscular prostration. Marked association of head and eye symptoms, with muscular tiredness and weariness. "Diminution of sexual desire. Headaches from eyestrain and one sided headaches of particularly the left side. Heaviness in the head, eyes, and body. Staggering gait. Craving for ice water and cold drinks. Generally worse from motion and jar. Pain in the back and knees. Vithoulkas mentions inability to use the hands properly and apathy with inability to focus the will power.
Differential:
Picric acid. This remedy known for brain fatigue and exhaustion
from mental overwork is also an excellent choice. Headache tends to be
occipital, urine production is diminished, and there tends to be an increased
sexuality.
Nux moschata: Stupefaction, dullness, and sleepiness due to neurologic cause make Nux moschata: a strong choice. Headache in this remedy is a bit more diffuse, of a bursting quality, and generally more prominent. Nux moschata has a more dreamy and the feeling of a drug induced quality to the stupor. This patient was more purely exhaustion, without the dreaminess.
Alumina: During the interview I saw no confusion of identity, no true slowness of answering, no impulsiveness. She had confusion that created angst, not confusion that created feeling of going insane. She has some dryness of skin. She tends to diarrhea and not constipation.
Gelsemium: Generally, the element of vertigo is a strong component of Gelsemium. The neurasthenia is a strong feature of this remedy, but one also looks for an element of sadness or depression which is lacking in this patient. Some spasmodic symptoms would also make this remedy more likely
Follow Up:
1/12/98: Nine months
after initial dose. Patient is now divorced and has moved to West Coast
to be closer to son. Overall, she has improved. Strength is gradually
improving. Able to eat more meals out of bed. Severe fatigue spells are
less frequent ( 6 times in 9 months compared to as much as every third
day), and shorter in duration (lasting 5 hours compared to 1-3 days).
She never requires assistance from others for her daily activities. Headaches
are of the same frequency but less intense. She still uses Depakote and
now Imitrex for the headaches. She is not working yet, but is considering
the possibility. Despite the divorce and recent move, she is overall significantly
improved. Given the duration, severity and generally decreased vitality,
I am very happy with the present course of things. Next follow up in 3-6
months.
This case was fun for me. Onosmodium is a small remedy in that
it is rarely
prescribed. I had a first hand opportunity to see how careful repertorization
and materia medica work can lead to the correct prescription of a remedy
I have never used, prior to this case. I enjoyed the detective work and
solving the riddle, and my patient has benefited wonderfully as well.
Case by case, through careful study and analysis, I believe we all have
the potential for mastery of this maddening discipline.
Todd Hoover MD practices in Narbeth, PA.
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