Botulism (other names are – Limberneck, Western Duck Sickness, Bulbar Paralysis, Alkali Disease) is a rare but life-threatening neuroparalytic syndrome caused by the botulinum neurotoxin, most often produced by the bacterium Clostridium botulinum.

The condition begins with symmetrical cranial nerve paralysis and progresses to descending, symmetrical weakness affecting the trunk and extremities, potentially leading to complete flaccid paralysis.

Botulism may be acquired through exposure to the preformed toxin via improperly stored food, processed or canned foods, iatrogenic injection, or bioterrorism.

Types of Botulism

Botulism is primarily categorized into 3 primary types based on the source of toxin exposure:

Foodborne

Foodborne botulism often presents with a prodrome of abdominal pain, nausea, and vomiting beginning 12 to 72 hours after ingestion of the preformed toxin. Constipation is a nearly universal eventual symptom.

Infant botulism

The presentation and severity of infant botulism are variable due to different inoculum sizes, host susceptibilities, and time to presentation. Early symptoms frequently involve constipation, weakness, feeding difficulties, a weak cry, and drooling. A “floppy baby” exhibiting global hypotonia.

Wound related

Wound botulism is the only variant presenting with fever and signs of infection but otherwise behaves similarly to foodborne botulism but with fewer gastrointestinal symptoms.

Iatrogenic botulism, through direct inoculation into the skin, presents similarly to wound and foodborne botulism.

Inhalational botulism, while rare, may cause affected individuals to experience an irritant upper airway prodrome before the onset of neurological complications. Otherwise, symptoms are expected to be similar to that of foodborne botulism, except the lethal dose from inhalational botulism is 3 times greater than that of foodborne botulism. 

Etiology

Botulism is a neuroparalytic syndrome that results from the systemic effects of a neurotoxin produced by the Gram-positive, rod-shaped, spore-forming, obligate anaerobic bacterium Clostridium botulinum and 6 other clostridial genospecies. The clostridial genospecies that produce 7 serologically distinct BoNTs, classified as BoNT/A-G, several of which have multiple serotypes, are as follows: C parabotulinum, C sporogenes, C botulinum, C novyi sensu lato, C baratii, C butyricum, and C argentinense. The BoNTS produced by C botulinum has seven different serotypes with varying prevalence: A, B C, D, E, F, and G. Most foodborne botulism cases worldwide are caused by BoNT types A, B, E, and F.

BoNT is considered the deadliest known toxin due to its extreme potency, with a lethal dose (LD50, the amount required to kill 50% of a test sample) of 1 to 3 ng/kg of body mass. The flaccid paralysis of botulism results from the irreversible inhibition of acetylcholine release at the presynaptic nerve terminal of the body’s neuromuscular junctions.

Toxicokinetics

After BoNT exposure, the time to symptom onset depends upon the toxin dose and the relevant absorption kinetics. For foodborne botulism, symptoms typically appear within 12 to 72 hours of ingesting contaminated food, although onset times from as little as 2 hours to as long as 8 days have been recorded. In one study, the results showed the incubation time for wound botulism was 4 to 14 days from the time of spore introduction. The median incubation period was 1 day, and the shortest reported was 2 hours.

For infectious (ie, wound and infant) botulism, the onset depends on the duration of spore exposure, the time required for germination, and the rate at which the resulting colonies produce enough BoNT to induce symptoms, which varies significantly based on bacterial species, toxin serotype, and the patient’s age and immunological status.

Elimination of BoNT from the blood is enhanced by administering serotype-specific neutralizing antibodies (antitoxins) to limit the total number of SNARE complexes affected by the toxin. BoNT is sequestered (isolate and/or hide) in the liver and spleen once bound by antitoxin.

Signs and symptoms

Botulism generally progresses as follows:

Preceding or following the onset of paralysis are nonspecific findings such as nausea, vomiting, abdominal pain, malaise, dizziness, dry mouth, dry throat, and, occasionally, sore throat. Respiratory muscle weakness may be subtle or progressive, advancing rapidly to respiratory failure. 

Autoimmune response

The autonomic nervous system is also involved in botulism (typically in cases caused by toxin type B), with manifestations that include the following:

• Paralytic ileus advancing to severe constipation,
• Gastric dilatation,
• Bladder distention advancing to urinary retention,
• Orthostatic hypotension,
• Reduced salivation,
• Reduced lacrimation.

Neurological

Other neurologic findings include the following:

• Changes in deep tendon reflexes, which may be either intact or diminished,
• Incoordination due to muscle weakness,
• Absence of pathologic reflexes and normal findings on sensory and gait examinations,
• Normal results on mental status examination.

Eyes

Ophthalmic manifestations may reflect the anticholinergic effects of the neurotoxins.

• Accommodation paresis, with blurred vision,
• Pupil dysfunction with mydriasis and poorly reactive pupils,
• Dry eye symptoms with impairment of lacrimation.

Ocular manifestations may be the manifesting features of botulism. However, their absence does not exclude this disease, since the 8 different toxins appear to involve the ocular system to various degrees.

History and Physical

Early clinical diagnosis of botulism is essential because the paralysis can quickly result in respiratory failure, and the antitoxin should be given as soon as possible. 

A complete travel, exposure, and risk factor history is essential to evaluate the possibility of ingestion or contamination of clostridial spores or toxins for example ingestion of canned, preserved, or fermented foods, use of injectable drugs, recent surgical procedures or injections, occurrence of contaminated wounds, any environmental exposure to soil containing clostridial endospores, and having received a dose of botulin for therapeutic or cosmetic purposes.

Bulbar symptoms

Botulism classically begins with cranial nerve palsies (“bulbar symptoms”) that progress to a symmetrical descending weakness of the trunk, extremities, and smooth muscles, with eventual flaccid paralysis.

However, these symptoms usually begin following early symptoms that include marked lassitude, diplopia, ptosis, ophthalmoparesis, dysphagia, dysphonia, and dysarthria, reflecting the high susceptibility of cranial nerve efferent presynaptic terminals to BoNT activity. Fixed and dilated pupils, resulting in blurred vision, can result from the inhibition of Ach release from the short ciliary nerves that innervate the sphincter muscles of the iris.

Patients usually have no sensory deficits except for blurred vision, although paresthesias are occasionally seen. Neurological sequelae are usually symmetrical without altered cognition or hemodynamic instability.

Diaphragm involvement precipitates respiratory failure, often requiring intubation and mechanical ventilation. Autonomic smooth muscle palsies cause constipation and urinary retention.

Tests required/Diagnosing botulism

Laboratory confirmation of botulism may be obtained with serum and stool assays for BoNT, gastric aspirates or rectal swabs, stool microscopy for spores, stool cultures, and wound cultures for wound botulism. Clostridium botulinum may be grown on selective media from samples of stool or foods.

The diagnosis initially must be made clinically, as waiting for laboratory confirmation would harmfully delay therapy.

The standard for laboratory diagnosis is a mouse neutralization bioassay confirming botulism by isolation of the toxin.

Electromyography 

Characteristic electromyographic findings in patients with botulism include the following:

• Brief, low-voltage compound motor-units,
• Small M-wave amplitudes,
• Overly abundant action potentials.

An incremental increase in M-wave amplitude with rapid repetitive nerve stimulation may help to localize the disorder to the neuromuscular junction.

Allopathic treatment for botulism

Many presentations of botulism are subtle and easily missed. However, the clinical course of a patient with botulism can evolve rapidly. Allopathic treatment typically proceeds based on clinical suspicion alone because laboratory confirmation of botulism takes several days, and therapy should be administered as early as possible. Obtaining a comprehensive medical history and performing a thorough physical examination are, therefore, essential. Botulism should be considered in any patient in whom Guillain-Barré or myasthenia gravis is suspected, and serial neurological examinations should be performed. 

Supportive treatment

Rigorous supportive care, including use of the following, is essential in patients with botulism:

• Meticulous airway management: Of paramount importance, since respiratory failure is the most important threat to survival in patients with botulism,
• Cathartics and enemas: Administered to patients with bowel sounds to remove unabsorbed botulinum toxin from the intestine,
• Stress ulcer prophylaxis: A standard component of intensive care management,
• Nasogastric suction and intravenous hyperalimentation: Helpful if an ileus is present; if no ileus is present, tube feeding can be used for nutritional supplementation,
• Foley catheter: Often used to treat bladder incontinence; the catheter must be monitored conscientiously and changed regularly,
• Antibiotic therapy: Useful in wound botulism but has NO role in foodborne botulism.

Wound botulism requires the following:

• Incision and thorough debridement of the infected wound,
• Antitoxin therapy,
• Penicillin G IV (metronidazole if penicillin-allergic),
• Tetanus toxoid booster.

Note

Magnesium salts, citrate, and sulfate should not be administered, because magnesium can potentiate the toxin-induced neuromuscular blockade.

Prevention of nosocomial infections

Measures to reduce the risk of nosocomial infections include the following:

• Close observation for hospital-acquired infections: Especially pneumonia (particularly aspiration pneumonia); precaution against aspiration also is necessary,
• Close observation for urinary tract infection,
• Meticulous skin care: To prevent decubital ulcers and skin breakdown.

Careful attention to peripheral and central intravenous catheters with regular site rotation to reduce the risks of thrombophlebitis, cellulitis, and line infections should be part of the patient’s supportive care.

Allopathic medication

The heptavalent antitoxin is derived from horse plasma and is the only allopathic drug available for treating botulism in patients older than 1 year. It also is the only available allopathic drug for treating infant botulism that is not caused by nerve toxin type A or B.

Botulism Antitoxin Heptavalent (A, B, C, D, E, F, G) – ideally should be administered within 24 hours of symptom onset as the antitoxin cannot reverse existing paralysis, only toxin circulating in the blood. The greatest benefit is seen among those who receive it within 2 days of illness onset. However, regardless of time after disease onset, patients should still receive antitoxin to protect unaffected synapes from persistent circulating toxin, which is known to persist for weeks in the blood.

The standard adult dose for patients >55 kg is one vial (10-22 mL per vial) diluted 1:10 in normal saline by slow intravenous infusion (0.5-2 mL/min)

As the half-lives of the antitoxin range from 7.5-34 hours, it is plausible that exposure to a high concentration of toxin may require a second dose of BAT. If disease progression worsens after the first dose should have taken effect and suspicion remains high (ie, known outbreak setting or exposure history), a second dose can be provided within 2 weeks (to avoid developing hypersensitivity reaction to the antitoxin).

Pregnant patients with suspected botulism should be treated with BAT just as nonpregnant patients,

Antibiotics

Antibiotics have no role in the treatment of foodborne or intestinal botulism. Wound botulism may require surgical debridement and antibiotic therapy because of wound infection (Clostridium – with penicillin or metronidazole).

Aminoglycosides should be avoided in patients with botulism as they may aggravate disease through inhibition of presynaptic calcium uptake, which is required for acetylcholine release.

Wound botulism requires incision and thorough debridement of the infected wound, antitoxin therapy, and antibiotics should be provided as clinically indicated.

Penicillin G aqueous (Crystapen, Penicillin G potassium, Penicillin G sodium)

Preferred drug of choice for wound botulism. Interferes with synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity against susceptible microorganisms. 

Supportive Care

Patients with botulism-induced flaccid paralysis typically do not experience impairment in sensory or cognitive functions directly from the toxin’s effects. ^[1, 2] Therefore, a focused approach to managing paralysis while ensuring overall health is crucial. Supportive care in botulism management involves extensive interventions to address paralysis and related complications, emphasizing the maintenance of vital functions and the prevention of deterioration.

Respiration and oxygenation

Proper airway management is paramount in botulism cases due to the elevated risk for respiratory failure. Close monitoring and prompt intervention are essential to ensure adequate oxygenation. Hospitalization generally is recommended for patients with symptoms or toxin exposure to allow continuous observation and timely interventions if needed.

Regular assessment of respiratory parameters such as spirometry, pulse oximetry, and arterial blood gases aids in monitoring the respiratory status and guiding treatment decisions. Respiratory failure can progress rapidly; early recognition and intervention, including intubation and mechanical ventilation, are crucial.

Ventilation

Promptly initiate ventilatory support, because respiratory muscle weakness rapidly progresses and the gag reflex frequently is impaired, which predisposes patients to respiratory failure and/or aspiration. Patients need continued suctioning and may require intubation or tracheostomy.

Homeopathic Treatment for botulism

As we know that many presentations of botulism are subtle and easily missed, the clinical course of a patient with botulism can evolve rapidly. Homeopathic treatment typically proceeds based on clinical suspicion alone because laboratory confirmation of botulism takes several days, and therapy should be administered as early as possible.

Obtaining a comprehensive medical history and performing a thorough physical examination and neurological examinations, Homeopathic treatment should be started as soon as possible. Homeopathic treatment for botulism is short, cheap and having no side effects and/or complications.

Here are few best medicines for the treatment of botulism:

Botulinum

Food poisoning from canned foods. Bulbar paresis. Ptosis, double vision, blurred vision. Difficulty in swallowing and breathing, choking sensation; weakness and uncertainty in walking, “blind staggers”, dizziness, thickening of speech. Cramping pain in stomach. Mask-like expression of face, due to weakness of facial muscles. Severe constipation.

 Psoralea corylifolia (Babchi or Bakuchi)

Paralysis. Thyroid diseases, rheumatoid arthritis, type 1 diabetes mellitus, psoriasis, systemic lupus, pernicious anemia. Diuretic and diaphoretic. Skin infections. Vitiligo. Leprosy, leukoderma. It tonify kidney, replenish spleen and stops diarrhea. It is also effective in treating impotence and spermatorrhea due to kidney, as well lumbago, diarrhea, and dyspnea caused by kidney. A good cardiotonic and vasodilator. Asthma. Antitumor, antibacterial, cytotoxic, and anti-helminthic properties and locally used for alopecia, inflammation, leukoderma, leprosy, psoriasis, and eczema. dental caries etc.

Arsenicum Album

Anguish and restlessness. Expression of agony. Suicidal. Hallucinations of smell and sight. Hemicrania, with icy feeling of scalp and great weakness. Burning in eyes, with acrid lachrymation. Lids red, ulcerated, scabby, scaly, granulated. Intense photophobia. Ciliary neuralgia, with fine burning pain. Throat swollen, edematous, constricted, burning, unable to swallow. Diphtheritic membrane dry and wrinkled. Fears suffocation. Air-passages constricted. Asthma worse midnight. Burning in chest. Suffocative catarrh.

Liver and spleen enlarged and painful. Painful, spasmodic protrusion of rectum. Tenesmus. Dysentery dark, bloody, very offensive. Cholera, with intense agony, prostration, and burning thirst. Urine scanty, burning, involuntary. Bladder as if paralyzed. Albuminous. Epithelial cells; cylindrical clots of fibrin and globules of pus and blood.

Extremities – trembling, twitching, spasms, weakness, heaviness, uneasiness. Cramps in calves. Sciatica. Burning pains. Peripheral neuritis. Diabetic gangrene. Ulcers on heel. Paralysis of lower limbs with atrophy.

Skin – itching, burning, swellings; edema, eruption, papular, dry, rough, scaly. Malignant pustules. Ulcers with offensive discharge. Anthrax. Poisoned wounds. Urticaria, with burning and restlessness. Psoriasis. Scirrhous. Icy coldness of body. Epithelioma of the skin. Gangrenous inflammations.

Sleep disturbed, anxious, restless. High temperature. Septic fevers. Intermittent. Paroxysms incomplete, with marked exhaustion. Cold sweats. Complete exhaustion. Delirium. Great restlessness.

Colocynthis

Extremely irritable. Neuralgic pains. Cramps and twitching and shortening of muscles. Cystospasm. Lateral cutting headache, with nausea, vomiting. Severe eye pain. Very bitter mouth taste. Colic with cramps in calves. Dysenteric stool renewed each time by the least food or drink. Jelly-like stools. Musty odor. Intense urethral burning. Contraction of muscles. All the limbs are drawn together. Pain in deltoid, in hip. Stiffness of joints and shortening of tendons. Sciatic pain, muscles and tendons feel too short, numbness with pains. Pain in knee joint. 

Hypericum Perforatum

A best choice for injuries to nerves. Lockjaw. Punctured wounds. Facial neuralgia. Pain in nape of neck. Pressure over sacrum. Spinal concussion. Coccyx injury, with pain radiating up spine and down limbs. Jerking and twitching of muscles.

Darting pain in shoulders. Pressure along ulnar side of arm. Cramp in calves. Pain in toes and fingers, especially in tips. Crawling in hand and feet. Lancinating pain in upper and lower limbs. Neuritis, with tingling, burning pain, numbness and flossy skin. Joints feel bruised. Hysterical joints. Tetanus. Traumatic neuralgia and neuritis.

Asthma. Hyperhidrosis, sweating of scalp, falling of hair from injury. Eczema, intense itching, eruption seems to be under the skin. Herpes zoster. Ulcers or sores in mouth – very sensitive. Lacerated wounds with prostration from loss of blood.

 China Officinalis

Drowsiness. Unrefreshing or constant stupor. Skin extreme sensitiveness to touch. Indurated glands; scrofulous ulcers and caries. Weariness of joints.  Influenza, with debility. Asthma. Undigested, frothy, yellow; painless stool. Flatulent colic. Liver and spleen swollen and enlarged. Jaundice. Sallow complexion. Hearing sensitive to noise. Lobules red and swollen. Tinnitus.

Physostigma Venenosum

Contraction of the pupil and of the ciliary muscles. Spinal irritation, loss of motility, prostration, with very sensitive vertebrae Fibrillary tremors. Rigidity of muscles; paralysis. Depressed motor and reflex activity of the cord and loss of sensibility to pain, muscular weakness, followed by complete paralysis, (muscular contractility is not impaired). Paralysis and tremors, chorea. Meningeal irritation, with rigidity of muscles. Tetanus and trismus. Poliomyelitis anterior. Cerebro-spinal meningitis; general tetanic rigidity. Spastic conditions of the face-muscles.

Burning and tingling in spine. Hands and feet numb. Sudden jerking of limbs on going to sleep. Tetanic convulsions. Locomotor ataxia. Numbness in paralyzed parts, crampy pains in limbs. Night-blindness, photophobia; contraction of pupils; twitching of ocular muscles. Lagophthalmos. Muscae volitantes; flashes of light; partial blindness. Glaucoma; paresis of accommodation; astigmatism. Profuse lachrymation. Spasm of ciliary muscles, with irritability. Increasing myopia. Post-diphtheritic paralysis of eye and accommodation muscles. 

Kali Bromatum

Cholera infantum, with reflex cerebral irritation, jerking and twitching of muscles. Green, watery stools with intense thirst, vomiting, eyes sunken. Prostration. Internal coldness of abdomen. Diarrhea, with much blood. Green, watery stools. Retraction of abdomen. Spasmodic croup. Reflex cough. Fidgety hands; busy twitching of fingers. Jerking and twitching of muscles. Acne, pustules. Itching; worse on chest, shoulders and face. Skin senselessness. Psoriasis. Extreme drowsiness.

Bryonia Alba

Skin yellow; pale, swollen, dropsical; hot and painful. Seborrhea. Sever temperature. Easy, profuse perspiration. Rheumatic and typhoid marked by gastro-hepatic complications. Drowsy. Delirium. Knees stiff and painful. Hot swelling of feet. Joints red, swollen, hot, with stitches and tearing pain. Liver region swollen, sore, tensive. Burning pain, stitches. Throat dryness, sticking on swallowing. Physical weakness. Exceedingly irritable.

Veratrum Album

A perfect picture of collapse, with extreme coldness, blueness, and weakness. Post-operative shock with cold sweat on forehead, pale face, rapid, feeble pulse. Cold perspiration. Vomiting, purging, and cramps in extremities. Excessive dryness of all mucous surfaces. “Coprophagia” violent mania alternates with silence and refusal to talk. Melancholy, with stupor and mania. Sits in a stupid manner. Delusions. Attacks of pain, with delirium driving to madness. Staring; turned upwards, without luster. Lachrymation with redness. Lids dry heavy.

Copious vomiting and nausea. Great weakness after vomiting. Gastric irritability with chronic vomiting of food. Abdomen sensitive to pressure, swollen with terrible colic.

Palpitation with anxiety and rapid audible respiration. Pulse irregular, feeble. Intermittent action of heart in feeble persons with some hepatic obstruction. Soreness and tenderness of joints. Sciatica. Cramps in calves. Neuralgia in brachial plexus; arms feel swollen, cold, paralytic.

Skin blue, cold, clammy, inelastic, cold as death. Cold sweat. Wrinkling of skin of hands and feet. Fever. Chill, with extreme coldness and thirst.

Ipecacuanha

Body stretched stiff, followed by spasmodic jerking of arms towards each other. Shocks in all limbs on going to sleep. Dyspnea; constant constriction in chest. Asthma. Yearly attacks of difficult shortness of breathing. Amebic dysentery with tenesmus. Mouth, moist; much saliva. Constant nausea and vomiting, with pale, twitching of face. Vomits food, bile, blood, mucus. Periodical orbital neuralgia, with lachrymation, photophobia, and smarting eyelids. Profuse lachrymation. Cornea dim. Eyes tire from near vision. State of vision constantly changing. Spasm of accommodation from irritable weakness of the ciliary muscle. Nausea from looking on moving objects.

Carbo Vegetabilis

Blood seems to stagnate in the capillaries, causing blueness, coldness, and ecchymosis. Body becomes blue, icy-cold. Bacteria find a rich soil in the nearly lifeless stream and sepsis and typhoidal state ensues. Moist skin; hot perspiration; senile gangrene.  Indolent ulcers, burning pain. Ichorous, offensive discharge; tendency to gangrene of the margins. Purpura. Varicose ulcers, carbuncles. Extremities heavy, stiff; feel paralyzed; limbs, go to sleep; want of muscular energy; joints weak. Pain in shins. Cramp in soles; feet numb and sweaty. Cold from knees down. Toes red, swollen. Burning pain in bones and limbs. Cough with itching in larynx; spasmodic with gagging and vomiting of mucus. Vision of black floating spots. Asthenopia. Burning in eyes. Muscles pain. Aversion to darkness. Fear of ghosts. Sudden loss of memory. 

Ignetia Amara

Jerking of limbs. Pain in tendo-Achillis and calf. Ulcerative pain in soles. Itching, nettle-rash. Very sensitive to draught of air. Excoriation, especially around vagina and mouth. Jerking of limbs on going to sleep. Jerking of limbs. Pain in tendo-Achillis and calf. Ulcerative pain in soles. Dry, spasmodic cough in quick successive shocks. Spasm of glottis. Reflex coughs. Coughing increases the desire to cough. Much sighing. Hollow spasmodic cough. Rumbling in bowels. Weak feeling in upper abdomen.

Cannot swallowed. Tendency to choke, globus hystericus. Sore throat: stitches when not swallowing. Stitches between acts of swallowing. Stitches extend to ear. Tonsils inflamed, swollen, with small ulcers. Follicular tonsillitis. Mouth constantly full of saliva. Twitching of muscles of face and lips. Changes color. Asthenopia, with spasms of lids and neuralgic pain about eyes (Nat m). Flickering zigzags. Congestive headaches following anger or grief

Phosphorus

Paralysis, Restless, fidgety. Hypo-sensitive, Vertigo, Heat from spine, Neuralgia, Burning pains. Chronic congestion of head; Brain-fag, Hippocratic face readings, ascending sensory and motor paralysis from ends of fingers and toes, Weakness and trembling, from every exertion. Locked-in syndrome. Arms and hands become numb, post-diphtheritic paralysis. Fatigue of eyes and head even without much use of eyes. Hearing difficult, especially to human voice. Re-echoing of sounds. Pale, sickly complexion; blue rings under eyes. Hippocratic countenance. Tearing pain in facial bones; face pale, sickly complexion; blue rings under eyes. Hippocratic countenance. Tearing pain in facial bones

Liver congested. Acute hepatitis. Aphonia. Violent palpitation with anxiety. Ascending sensory and motor paralysis from ends of fingers and toes. Stitches in elbow and shoulder joints. Burning of feet. Weakness and trembling. Can scarcely hold anything. Tibia inflamed and became necrosed. Arms and hands – numbed. Post-diphtheritic paralysis. Joints suddenly give way. Great drowsiness. Wounds bleed very much, even if small. Little ulcer outside of large ones. Petechiae. Ecchymosis. Purpura haemorrhagia. Scurvy.

Mygale Lasiodora

It is quite characteristic of the spider poisons to produce spasmodic diseases. Depressed muscles of the face twitch constantly, the mouth and eye open and close in rapid succession, patient jerks his head to one side, usually the right control over the muscle seems to be lost, If the patient attempts to put his hand to his head it is jerked backwards violently, and words are jerked out in talking, The legs are in motion while sitting, and dragged while attempting to walk. Paralysis.

Uncontrollable Movements of face, arms, and legs, involuntary head movements, throwing the head backward and then forwards are prominent, constant jerking of the head (mostly to the right side). Locked-in syndrome. Shrugging of shoulders. Difficulty in putting out tongue, grating teeth at night.

Agaricus Muscarius

Paralysis with uncertain, unsteady Gait –  Agaricus is well-indicated for cases of paralysis where an uncertain, Colic spasms when awake, quiet when asleep, Though jerking when going to sleep; spasmodic motions, from simple involuntary motions and jerks of single muscles to a dancing of the whole body, Attack crosswise ,an upper right and a lower left extremity, or vice versa, Convulsive condition of the muscles of head and neck, constantly, Extreme mobility of lower limbs and the body generally, Frequent nictitating of eyelids; twitching and spasms of eyeballs; redness of inner canthi of eyes; lachrymation. Locked-in syndrome. 

Body convulsed. Cervical glands swollen; inarticulate speech, itching of eyelids and of different spots on skin, resembling chilblains; weakness and coldness of limbs; unsteady walk. Facial muscles feel stiff; twitch; face itches and burns. Lancinating, tearing pain in cheeks, as of splinters.  Burning and smarting on lips. Tremulous tongue.

Reading difficult, words move and swim. Vibrating specters. Double vision, dim and flickering. Asthenopia. Twitching of lids and eyeballs. Stitching pains in liver and spleen. Irregular, tumultuous palpitation. Pulse intermittent and irregular. Skin burning, itching, redness, and swelling, pimples, hard. Miliary eruption, with intolerable itching and burning. Chilblains. Angioneurotic oedema; rosacea. Swollen veins with cold skin. Circumscribed erythematous, papular and pustular and edematous.

Cina

Dilated pupils; yellow vision. Weak sight. Strabismus. Eyestrain, especially when presbyopia sets in. Pulsation of super ciliary muscle. Digging and scratching in ears. Intense, circumscribed redness of cheeks. Pale, hot, with dark rings around eyes. Cold perspiration. White and bluish about the mouth. Grits teeth during sleep. Chorea movements of face and hands. Locked-in syndrome.

Paralysis of the face and upper limbs. Involuntary movements on the face and around the eyes. Throwing of arms from side to side. The limbs are distorted with jerking and trembling. Weakness of the hands, making it difficult to hold things. Complaints usually appear on one side. Few general symptoms like irritability, screaming, striking and restless sleep may also be present.

Causticum

A best and prominent medicine for paralysis. Causticum is most indicated when the right side of the body is more affected – the face, tongue, arm, and leg. Marked twisting and jerking of limbs. Locked-in syndrome. An unsteady gait is present with involuntary body movements Weakness of muscles.

Sparks and dark spots before eyes Ptosis. Vision impaired.  Paralysis of tongue. Hoarseness, aphonia.

Cuprum Metallicum

Spasmodic affections, cramps, convulsions, beginning in fingers and toes, violent, contractive, and intermittent pain. Paralysis. Locked-in syndrome. The arms and legs also feel weak, weary and lame. Muscle contractions. Jerking of hands. Can hold nothing in hand and the objects fall to the ground. Speech is affected with trembling of the tongue. Distorted, pale bluish, with blue lips. Contraction of jaws, with foam at mouth.

Choreic movements start in the muscles of the fingers and toes and extend to the limbs. The patient is better or quieter during sleep, but when awake the terrible contortions and awkward movements are excessive. Meningitis. Spasm and constriction of chest; spasmodic asthma, alternating with spasmodic vomiting.

Magnesia Phosphoricum

Chorea or Hemiplegia and paralysis when Symptoms are Better During Sleep, Magnesia Phos is an important medicine. Locked-in syndrome. Involuntary shaking of limbs, face, mouth, and head is present. Involuntary movements of limbs along with contortions may also appear. Asthmatic oppression of chest. Dry, tickling cough. Spasmodic cough

Sudden forward motion of the head is well-noted, jerking of the mouth and speech is also very defective. Supraorbital pains. Twitching of lids. Nervous spasmodic palpitation. Constricting pains around heart.

Veratrum Viride

For Chorea, paralysis or Hemiplegia when Symptoms are Worse during Sleep. Locked-in syndrome. Involuntary motions of facial muscles (face turned into horrible contortions), jerking/continual nodding of the head, jerking of arms and legs, Constant movement of the lower jaw, speech affected, with the dropping of words when speaking.

Congestion of lungs. Difficult breathing. Pulse slow, soft, weak, irregular, intermittent or rapid pulse, low tension. Constant, dull, burning pain in region of heart. 

Secale Cornutum

Secale Cor is used in cases of paralysis, chorea or Hemiplegia when the chief indication is symptoms beginning in the face and then spreading all over the body. The symptoms may become severe and rise to dance and jumping. Locked-in syndrome. The arms and legs are in constant motion. Head movement from side to side is present, trunk in constant motion, tongue jerks out and speech becomes difficult and indistinct.

Pupils dilated. Face pale, pinched, sunken. Cramps commence in face and spread over whole body. Livid spots on face. Spasmodic distortion. Tingling of tip of tongue, which is stiff. Tongue swollen, paralyzed. Skin shriveled, numb; mottled dusky-blue tinge.

Kali Bromatum

Violent cases of paralysis of any type, locked-in syndrome, chorea or Hemiplegia that arises from fright. Great trembling of hands (Legs and arms are affected). The gait is unsteady, irregular, and staggering (similar to a drunk person walking), facial muscles could be affected, the tongue protrudes with a jerk, and the person can barely speak. All the movements are violent.

Cholera infantum, with reflex cerebral irritation, jerking and twitching of muscles. Green, watery stools with intense thirst, vomiting, eyes sunken. Prostration. Fidgety hands; busy twitching of fingers. Jerking and twitching of muscles. Acne, pustules. Itching; worse on chest, shoulders, and face. Anesthesia/senselessness of skin. Psoriasis. Restless sleep. Extreme drowsiness.

Saccharum Lactis (Lactulose)

Amblyopia. Angina pectoris. Body-odor, offensive. Diabetes. Dyspepsia. Earache. Gout. Headache. Hysteria. Labia, soreness of. Nervousness. Neuralgia. Ovaries, affections of. Over-exertion. Ptosis. Sciatica. Sighing. Paralysis. Trembling of whole body. Longing and melancholy. Hysteria in evening, laughing and crying, jumping up and lying down, but could not stand. Locked-in syndrome. Left side of head felt all drawn. Inflammation and awful pain in lower limbs extending down.

Belladonna and Atropinum

Atropine is an alkaloid of Belladonna (C17 H23 NO3). Belladonna acts primarily on the brain, great general sensitiveness, sensitiveness of the special senses-sensitive to light, hydrophobia, remarkable quickness of sensation and/or of motion. Paralysis. Locked-in syndrome. Melancholy with grief, hypochondriacal humor, moral dejection, and discouragement, delirium and mania with groaning, disposition to dance, to laugh, to sing, and to whistle.

Mania, with groans, or with involuntary laughter; nocturnal delirium; delirium with murmuring; delirium, during which are seen wolves, dogs, fires, &c; delirium by fits, and sometimes with fixedness of look, Stupefaction, with congestion to the head; pupils enlarged.

Delirium. Great apathy and indifference, desire for solitude, dread of society and of all noise. Repugnance to conversation. Disinclination to talk, or very fast talking. Ill-humor, disposition irritable and sensitive, with an inclination to be angry and to give offence. Folly, with ridiculous jesting, gesticulations, acts of insanity, impudent manners.

Fury and rage, with desire to strike, to spit, to bite, and to tear everything, and sometimes with growling and barking like a dog. Dejection and weakness of mind and body. Dread of all exertion and motion. Loss of consciousness. Fantastic illusions (when closing the eyes). Dementia to such an extent as no longer to know one’s friends, illusions of the senses and frightful visions. Complete loss of reason, stupidity, inadvertence, and distraction, inaptitude for thought, and great weakness of memory. Memory: quick; weak; lost.

Sepia Officanalis

Convulsive motions of head and limbs, when talking jerking of facial muscles, General muscular agitation; desire to change constantly place and position, Ringworm like eruptions on skin every spring; uterine chorea with menstrual irregularities; Amelioration after menses and after a thunderstorm. Paralysis. Locked-in syndrome.

Opium

Locked-in syndrome. Emotional chorea: trembling the head, arms and hands. Arms are thrown out at right angles with the body and spasmodic jerking of the flexors; convulsive movements of one or other arm to and fro, Twitching continue during sleep. Paralysis. Falls into a heavy stupid sleep. Profound coma. Opisthotonos. Swollen veins of neck. Painless paralysis. Twitching of limbs. Numbness. Jerks as if flexors were overacting. Convulsions; worse from glare of light; coldness of limbs.

Tarentula Hispanica

Paralysis. Locked-in syndrome, Chorea or Hemiplegia: Tarentula Hispanica indicated when the paralysis movements affect the right arm and right leg, and when the movements continue even at night, and are brought on by fright, grief, etc. restless and compelled to keep constantly in motion, the spine is sensitive, and there is trembling.

The patient can run better than he can walk, it is the remedy when diversion of the mind, especially music, relieves.

Zincum Metallicum

Constant motion of the feet, which may continue during sleep, it is especially the medicine when the paralysis is brought on by suppressed eruption or by fright, The general health is involved, right side most affected, Much depression and irritability. Locked-in syndrome. Chorea.

Pterygium; smarting, lachrymation, itching. Amaurosis, with severe headache. Red and inflamed conjunctiva. Burning pressure beneath sternum. Constriction and cutting in chest. Hoarseness. Debilitating, spasmodic cough. Varicose veins, especially of lower extremities.

Cimicifuga Racemosa

Paralysis any type and stage, locked-in syndrome, muscle pain or rheumatic joint ailments, or when reflex from uterine derangements, then Cimicifuga is the remedy, There is sensitiveness of the spine and entire muscular system, If mental depression be present it is an additional indication, Cimicifuga is especially indicated in chorea in young girls, about the age of puberty, with menstrual disorders, especially suppression of menses, Fright chorea and chorea with loss of power of swallowing indicate the remedy, Sleeplessness is an important symptom, Difficult speech, patient bites tongue when talking are good indications.

Asthenopia. Tickling in throat. Dry, short cough. Nausea and vomiting caused by pressure on spine and cervical region. Sinking in epigastrium. Gnawing pain. Tongue pointed and trembling.  Tickling in throat, throat spasmodic, dry with muscular soreness and nervous irritation. Irregular, slow, trembling pulse. Irregular, slow, trembling pulse. Tremulous heart’s action.

Cadmium Sulphuratum

Unconscious. Vertigo. The mouth gets distorted, with difficulty in swallowing and speaking in such cases. Unconscious. Vertigo: room and bed seem to spin around. Hammering in head. Heat in head. Distortion of mouth. Trembling of jaw. Facial paralysis. Difficult swallowing. Esophagus constricted. Salty belching. Intense nausea, with pain and cold. Stringy, offensive exudation on mucous membrane. Salty taste.

One pupil dilated. Night blindness. Difficult swallowing. Esophagus constricted. Region of liver sore. Coldness. Black, offensive clots of blood from bowels. Pain in abdomen, with vomiting. Tenderness and tympanites. Skin blue, yellow, sallow, scaly, cracking. Itching; better scratching. Chloasma, yellowish stains on nose and cheeks Chilblains.

Baptisia Tinctoria

Wild, wandering feeling. Inability to think. Mental confusion. Ideas confused. Illusion of divided personality. Thinks he is broken or double and tosses about the bed trying to get pieces together. Locked-in syndrome. Delirium, wandering, muttering. Perfect indifference. Falls asleep while being spoken to. Melancholia, with stupor. Confused, swimming feeling. Vertigo; pressure at root of nose. Skin of forehead feels tight; seems drawn to back of head. Feels too large, heavy, numb. Soreness of eyeballs. Brain feels sore. Stupor; falls asleep while spoken to. Early deafness in typhoid conditions. Eyelids heavy.

Besotted look. Dark red. Pain at root of nose. Muscles of jaw rigid. Taste flat, bitter. Teeth and gums sore, ulcerated. Breath fetid. Tongue feels burned; yellowish-brown; edges red and shining. Dry and brown in center, with dry and glistening edges; surface cracked and sore. Can swallow liquids only, least solid food gags.  Neck tired. Stiffness and pain, aching and drawing in arms and legs. Pain in sacrum.

Dark redness of tonsils and soft palate. Constriction, contraction of esophagus. Great difficulty in swallowing solid food. Painless sore throat, and offensive discharge. Contraction at cardiac orifice.

Arnica Montana

Fears touch, or the approach of anyone. Unconscious; when spoken to answers correctly, but relapses. Indifference: inability to perform continuous active work; morose, delirious. Nervous; cannot bear pain; whole body oversensitive. Says there is nothing the matter with him. Wants to be let alone. Agoraphobia (fear of space). After mental strain or shock. Locked-in syndrome.

Head hot, with cold body; confused; sensitiveness of brain, with sharp, pinching pains. Scalp feels contracted. Weakness of the muscles of the neck; the head falls backwards. Chronic vertigo: objects whirl about especially when walking. Locked-in syndrome. Diplopia from traumatism, muscular paralysis, retinal hemorrhage. Bruised, sore feeling in eyes. Must keep eyes open, dizzy on closing them. Feel tired and weary after sight-seeing, moving pictures, etc.

Noises in ear caused by rush of blood to the head. Shooting in and around ears. Blood from ears. Dullness of hearing after concussion. Pain in cartilages of ears as if bruised. Pain in extremities as if from fatigue and crawling in the arms and in the hands. Painful paralytic weakness in the joints. Over-sensitiveness of the whole body.

Epistaxis after every fit of coughing, dark fluid blood. Nose feels sore; cold. Fetid breath. Dry and thirsty. Bitter taste. Taste as from bad eggs. Soreness of gums after teeth extraction. Empyema of maxillary sinus. Face sunken; very red. Heat in lips. Herpes in face.

Conium Maculate

Depressed, timid, averse to society, and afraid of being alone. No inclination for business or study; takes no interest in anything. Memory weak; unable to sustain ‘any mental effort. Vertigo, when lying down, and when turning over in bed, when turning head sidewise, or turning eyes; worse, shaking head, slight noise or conversation of others, especially towards the left. Headache, stupefying, with nausea and vomiting of mucus. Paralysis. Locked-in syndrome. Tightness as if both temples were compressed, worse after a meal. Bruised, semi lateral pains. Dull occipital pain on rising in morning. Extremities heavy, weary, paralyzed; trembling; bands unsteady; fingers and toes numb. Muscular weakness, especially of lower extremities. Perspiration of hands. Putting feet on chair relieves pain.

Photophobia and excessive lachrymation. Corneal pustules. Dim-sighted; worse, artificial light. On closing eyes, he sweats. Paralysis of ocular muscles. In superficial inflammations, as in phlyctenule conjunctivitis and keratitis. The slightest ulceration or abrasion will cause the in tensest photophobia. Defective hearing; discharge from ear blood colored.

Gelsemium Sempervirens

Desire to be quiet, to be left alone. Dullness, languor, listless. “Discerning are lethargies.” Apathy regarding his illness. Absolute lack of fear. Delirious on falling to sleep. Emotional excitement, fear, etc. lead to bodily ailments. Bad effects from fright, fear, exciting news. Paralysis. Locked-in syndrome. Vertigo, spreading from occiput. Headache, with muscular soreness of neck and shoulders. Headache preceded by blindness; better, profuse urination. Delirious on falling asleep.

Eyes: Ptosis; eyelids heavy; patient can hardly open them. Double vision. Disturbed muscular apparatus. Corrects blurring and discomfort in eyes even after accurately adjusted glasses. Vision blurred, smoky. Dim-sighted; pupils dilated and insensible to light. Orbital neuralgia, with contraction and twitching of muscles. Bruised pain back of the orbits. One pupil dilated, the other contracted. Deep inflammations, with haziness of vitreous. Serous inflammations. Albuminuric retinitis. Detached retina, glaucoma and descemetitis. Hysterical amblyopia.

Neuralgia of face. Dusky hue of face, with vertigo and dim vision. Facial muscles contracted, especially around the mouth. Chin quivers. Lower jaw dropped. Putrid taste and breath. Tongue numbs, thick, coated, yellowish, tremble, paralyzed. Difficult swallowing, especially of warm food. Itching and tickling in soft palate and Naso-pharynx. Pain in sterno-cleidoic-mastoid, back of parotid.

Post-diphtheritic paralysis. Tonsillitis; shooting pain into ear. Feeling of a lump in throat that cannot be swallowed. Aphonia. Swallowing causes pain in ear. Difficult swallowing. Pain from throat to ear. Loss of power of muscular control. Cramp in muscles of forearm. Professional neuroses. Excessive trembling and weakness of all limbs. Hysteric convulsions. Fatigue after slight exercise. Complete relaxation of the whole muscular system.

Plumbum Metallicum

Weakness and tingling sensation in lower limbs which ascends to the upper part of the body, paralysis is chiefly of extensors, forearm or upper limb, from center to periphery with partial anesthesia or excessive hyperesthesia, preceded by pain. Localized neuralgic pains, neuritis.

Progressive muscular atrophy. Infantile paralysis. Locomotor ataxia. Excessive and rapid emaciation. Bulbar paralysis. Important in peripheral affections. Multiple sclerosis, posterior spinal sclerosis. Contractions and boring pain. Delirium, coma and convulsions. Hypertension and arteriosclerosis. Progressive muscular atrophy. Infantile paralysis. Bulbar paralysis. Important in peripheral affections.

Fear of being assassinated. Depression. Quiet melancholy. Slow perception; loss of memory; amnesic aphasia. Hallucinations and delusions. Intellectual apathy. Memory impaired. Paretic dementia. Delirium alternating with colic. Tinnitus. Pupils contracted. Yellow. Optic nerve inflamed. Intraocular, suppurative inflammation. Sudden loss of sight after fainting.

Tremor of Naso-labial muscles. Tongue tremulous, red on margin, feels paralyzed. Paralysis of single muscles. Extension is difficult. Paralysis from overexertion of the extensor muscles in piano players. Pains in muscles of thighs; come in paroxysms. Wrist-drop. Cramps in calves. Stinging and tearing in limbs, also twitching and tingling, numbness, pain or tremor. Pain in atrophied limbs alternates with colic. Loss of patellar reflex.

Curare

Muscular paralysis without impairing sensation and consciousness. Paralysis of respiratory muscles. Reflex action diminished. Debility of the aged and from loss of fluids. Catalepsy. Nervous debility. Trismus. Glycosuria with motor paralysis. Curare decreases the output of adrenaline. Vomiting of bile in cirrhosis of liver. Indecision; no longer wishes to think, or act for herself.

Lancinating pains all over head. Head drawn backward. Falling out of hair. Brain feels full of fluid. Facial and buccal paralysis. Tongue and mouth drawn. Red face. Tongue and mouth drawn to right. Sharp, stitching pains over eye. Black spots before vision. Ptosis.

Noises in ears; unbearable earache. Lancinating pains start from ears, extending down to legs. Swelling of lobes of ear.  Tired pain up and down spine. Locked-in syndrome, arms weak, heavy. Cannot lift the fingers. Weakness of hands and fingers in pianists. Legs tremble; give way in walking. Debility; paralysis. Catalepsy. Favors development of corns. Reflexes lessened or abolished.

Oxalicum Acidum

Gastro-enteritis, motor paralysis, collapse, stupor and death. Influences the spinal cord and produces motor paralysis. Pains very violent, in spots worse, motion, and thinking of them. Periodical remissions. Sense of heat in head. Confusion and vertigo. Headache, before and during stool. Hyperesthesia of retina.

Locked-in syndrome. Nervous aphonia with cardiac derangement. Burning sensation in throat. Breathing spasmodic, with constriction of larynx and chest. Aphonia. Paralysis of the tensors of vocal cord. Dyspnea; short, jerking inspirations. Sharp pain through lower region of left lung, extending down to epigastrium.

Extremities: Numb, weak, tingling. Pains start from spine and extend through extremities. Drawing and lancinating pains shooting down extremities. Backache; numb, weak, Myelitis. Muscular prostration. Wrist painful, as if sprained. Lower extremities blue, cold, insensible. Sensation of numbness. Multiple cerebral and posterior spinal sclerosis. Lancinating pains in various parts; jerking pains.

Picric Acid

Degeneration of the spinal cord, with paralysis. Acts upon the generative organs probably through the lumbar centers of the spinal cord, prostration, weakness and pain of back, pins and needle sensation in extremities. Neurasthenia. Muscular debility. Heavy tired feeling. Myelitis with spasms and prostration. Writer’s palsy. Progressive, pernicious anemia. Uremia with complete anuria. Sallow complexion. Locked-in syndrome.

Lack of will-power; disinclined to work. Cerebral softening. Dementia with prostration, sits still and listless. Occipital pain; worse, slightest mental exertion. Vertigo and noises in ear. After prolonged mental strain, with anxiety and dread of failure at examination. Brain fag.

Burning along spine. Great weakness. Tired, heavy feeling all over body; worse, exertion. Feet cold. Cannot get warm. Acute descending paralysis. Degeneration of the spinal cord, with paralysis. Brain fag and sexual excitement. Acts upon the generative organs probably through the lumbar centers of the spinal cord; prostration, weakness and pain of back, pins and needle sensation in extremities. Neurasthenia. Muscular debility. Heavy tired feeling. Myelitis with spasms and prostration. Writer’s palsy. Progressive, pernicious anemia. Uremia with complete anuria. Sallow complexion.

Nux Vomica

Very irritable: sensitive to all impressions. Ugly, malicious. Cannot bear noises, odors, light, etc. Does not want to be touched. Time passes too slowly. Even the least ailment affects her greatly. Disposed to reproach others. Sullen, fault-finding. Headache in occiput or over eyes, with vertigo; brain feels turning in a circle. Over sensitiveness. Vertigo, with momentary loss of consciousness. Photophobia; worse in morning. Smarting dry sensation in inner canthi. Infra-orbital neuralgia, with watering of eyes. Optic nerve atrophy, from habitual use of intoxicants. Paresis of ocular muscles. Orbital twitching radiating towards the occiput, Optic neuritis. Locked-in syndrome.

Throat: Rough, scraped feeling. Tickling after waking in morning. Sensation of roughness, tightness, and tension. Pharynx constricted. Uvula swollen. Stitches into ear.

Backache in lumbar region. Burning in spine. Servico-brachial neuralgia. Sitting is painful. Arms and hands go to sleep. Paresis of arms, with shocks. Legs numb; feel paralyzed; cramps in calves and soles. Partial paralysis, from overexertion or getting soaked. Drags feet when walking. Sensation of sudden loss of power of arms and legs in the morning.

Cocculus Indicus

Spasmodic and paretic affections, notably those affecting one-half of the body. Affects the cerebrum but will not cure convulsive seizures proceeding from the spinal cord. Painful contracture of limbs and trunk, tetanus. Sensation of hollowness, or emptiness, as if parts had gone to sleep. Feels too weak to talk loudly.

Mind capricious. Heavy and stupid. Time passes too quickly; absorbed in reveries. Inclination to sing irresistible. Slow of comprehension. Mind benumbed. Profound sadness. Cannot bear contradiction. Speaks hastily. Vertigo, nausea. Pupils contracted. Opening and shutting sensation, especially in occiput. Trembling of head. Pain in eyes as if torn out of head.

Locked-in syndrome. Paralysis of facial nerve. Cramp-like pain in masseter muscle; worse, opening mouth. Prosoplasia in afternoon, with wide radiations of pain. Cracking of cervical vertebrae when moving head. Paralytic pain in small of the back. Pain in shoulder and arms as if bruised. Pressure in scapula and nape. Stiffness on moving shoulders.

Extremities: Lameness; worse by bending. Trembling and pain in limbs. Arms go to sleep. One-sided paralysis; worse after sleep. Hands are alternately hot and cold; numbness and cold sweat now of one, now of the other hand. Numb and unsteady. Knees crack on motion. Lower limbs very weak. Inflammatory swelling of knee. Intensely painful, paralytic drawing. Limbs straightened out, painful when flexed.

Stannum Metallicum

Chief action is centered upon the nervous system and respiratory organs. Debility, especially the debility of chronic bronchial and pulmonary conditions. Paralysis. Paralytic weakness; spasms; paralysis. Locked-in syndrome. Sad, anxious. Discouraged. Dread of seeing people. Aching in temples and forehead. Obstinate acute coryza and influenza with cough. Pain worse motion; gradually increasing and decreasing as if constricted by a band; forehead feels pressed inwards. Jarring of walking resounds painfully in head. Drawing pains in malar bones and orbits.

Throat dry and stings. Paralytic weakness; drops things. Ankles swollen. Limbs suddenly give out when attempting to sit down. Dizziness and weakness when descending. Spasmodic twitching of muscles of forearm and hand. Fingers jerk when holding pen. Neuritis. Typewriters’ paralysis.

Lathyrus Sativus

Affects the lateral and anterior columns of the cord. Reflexes always increased. Paralytic affections of lower extremities; spastic paralysis; lateral sclerosis; Beri-Beri. Athetosis. Infantile paralysis. After influenza and wasting, exhaustive diseases where there is much weakness and heaviness, slow recovery of nerve power. Sleepy, constant yawning. Paralysis. Locked-in syndrome. Depressed. Vertigo when standing with eyes closed.

Burning pain in tip of tongue; with tingling and numbness of tongue and lips, as if scalded. Tips of fingers numb. Tremulous, tottering gait. Excessive rigidity of legs; spastic gait. Knees knock against each other when walking. Rheumatic paralysis. Gluteal muscles and lower limbs emaciated. Legs blue; swollen, if hanging down. Stiffness and lameness of ankles and knees, toe do not leave the floor, heels do not touch floor, Muscles of calves very tense. Patient sits bent forward, straightens with difficulty. Tips of fingers numb. Tremulous, tottering gait. Excessive rigidity of legs; spastic gait. Knees knock against each other when walking.

Oleander

Cramp-like contractions of upper extremities. Hemiplegia. Paralysis. Difficult articulation. Memory weak; slow perception. Melancholy, with obstinate constipation. Vertigo and diplopia, when looking down. Vertigo, when looking fixedly at an object, and on rising in bed. Pain in brain. Numb feeling. Dull, unable to think. Indolence. Eruption on scalp. Humid, fetid spots behind ears and occiput, with red, rough, herpetic spots in front. Corrosive itching on forehead and edge of hair; worse, heat.

Asthmatic when lying down. Palpitation, with weakness and empty feeling in chest. Dyspnea. Obtuse stitches in chest. Weakness of lower limbs. Paralysis of legs and feet. Want of animal heat in limbs. Cold feet. Painless paralysis. Constant cold feet. Swelling, burning stiffness of fingers. Veins and hands swollen. Edema. Stiffness of joints. Skin sensitive and numb. Nocturnal burning. Very sensitive skin.

Lathyrus Sativus

Affects the lateral and anterior columns of the cord. Reflexes always increased. Paralytic affections of lower extremities; spastic paralysis; lateral sclerosis; Beri-Beri. Athetosis. Infantile paralysis. After influenza and wasting, exhaustive diseases where there is much weakness and heaviness, slow recovery of nerve power. Sleepy, constant yawning. Depressed; hypochondriacal. Vertigo when standing with eyes closed. Burning pain in tip of tongue; with tingling and numbness of tongue and lips.

Tips of fingers numb. Tremulous, tottering gait. Excessive rigidity of legs; spastic gait. Knees knock against each other when walking. Cramps in legs worse cold, and cold feet. Cannot extend or cross legs when sitting. Myelitis, with marked spastic symptoms. Rheumatic paralysis. Gluteal muscles and lower limbs emaciated. Legs blue; swollen, if hanging down. Stiffness and lameness of ankles and knees, toe do not leave the floor, heels do not touch floor, Muscles of calves very tense. Patient sits bent forward, straightens with difficulty. Increased bladder reflex. Frequent, must hurry, else voided involuntarily.

Oxytropis Lamberti

Marked action on nervous system. Trembling, sensation of emptiness. Walks backwards. Congestion of spine and paralysis. Pains come and go quickly. Sphincters relaxed. Staggering gait. Reflexes lost. Desires to be alone. Disinclined to work or talk. Worse, thinking of symptoms. Depression. Vertigo. Pain in maxillary bones and masseter muscles. Mouth and nose dry.

Eyesight obscured; pupils contracted; do not respond to light. Paralysis of nerves and muscles of eyes.

Stomach: Eructation with colicky pains. Epigastrium tender. Sphincter seems relaxed. Stools slip from anus, like lumps of jelly, mushy. Urging to urinate when thinking of it. Profuse flow. Pain in kidneys.

Male: No desire or ability. Pain in testicles and along spermatic cord and down thighs.

Pain along ulnar nerve. Numb feeling about spine. Staggering gait. Loss of co-ordination. Patellar tendon reflex lost. Pains come and go quickly, but muscles remain sore and stiff. Sleep restless, dreams of quarrel.

Prognosis

With allopathic treatment, the prognosis of patients with locked-in syndrome varies from fair to poor; On the other hand, with Homeopathic treatment prognosis of locked-in syndrome is very good.

Patients with allopathic supportive care (that includes development of ways to communicate with other people usually do better than those diagnosed at a later time) takes sometimes months to years later. The majority of patients with locked-in syndrome do not recover functionality with allopathic treatment, rarely, the patient may recover some basic functionality.

Complications

P. S: This article is only for doctors and students having good knowledge about Homeopathy and allopathy.

For proper consultation and treatment, please visit our clinic.

Dr. Sayyad Qaisar Ahmed (MD {Ukraine}, DHMS), Abdominal Surgeries, Oncological surgeries, Gastroenterologist, Specialist Homeopathic Medicines.

  Senior research officer at Dnepropetrovsk state medical academy Ukraine.

Location:  Al-Haytham clinic, Umer Farooq Chowk Risalpur Sadder (0923631023, 03119884588), K.P.K, Pakistan.

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