Craniosacral therapy and post-traumatic seizures: A case report

Journal of the American Chiropractic Association, Nov 2002 by Henniger, Ronald

Presenting Complaint and Prior History

The patient was a 7-year-old female that had started to have seizures right after an automobile accident. Both her mother and she denied that seizures existed prior to the accident. The car, driven by her mother, was hit on the driver's side at the passenger door area. The girl leaned or ducked toward her mother. When her seat belt broke at the instant of impact, she slid behind her mother and hit the top of her head on the driver's side door.

We saw this patient at our clinic three months after the motor vehicle accident at the request of a chiropractor who had been treating her spinal complaints related to the accident. The patient had also been seen by a neurologist for the seizures. During this period, she had been placed on several seizure medications, including Phenytoin (Dilantin) and phenobarbital. These medications had minimal effect at controlling the seizures and resulted in severe side effects. After discussion between the parent and the prescribing medical physician, the recommendation was for the girl to stop taking the medication. At this time, she was referred to a pediatric neurologist.

The pediatric neurologist found that the seizures could he brought on by hyperventilation and flashing lights, especially when the girl became overheated. The neurologist diagnosed traumatic epilepsy (ICD codes 346.9, 907.0). The pediatric neurologist agreed not to attempt medication due to her previous lack of improvement with drugs, and the side effects that accompanied them.

Additional History

When I saw the patient, the following history information was elicited:

* The patient described her seizures as beginning with blacking out for a little while, starting as she focused in on an object; someone had to bring her out of a trancelike state that lasted about two minutes.

* There was mild limb movement, starting in the left foot and proceeding up the leg. It also involved the right hand and proceeded up the right arm. To stop these movements, she had to place her right foot on her left foot to keep it from moving and also grab her right hand with her left to keep the hand and arm from shaking.

* She had one grand mal seizure that was witnessed by her mother, who heard movement from her daughter's room. When the mother arrived, she saw that all four limbs were thrashing about, followed by her daughter's body going totally rigid for about 30 seconds.

* The patient denied her sleep had been affected, but her mother stated that she did not sleep as well or as long, and that her sleep was restless. The patient complained of having nightmares and was afraid to go to sleep at night.

* She stated that she had a tendency to fall or seemed to be unsteady to the left. When she felt dizzy, the room always rotated in a counter-clockwise manner.

Examination Findings

Upon examination, all cranial nerves were intact. The long tract signs were absent (pathological reflexes, superficial reflexes, deep tendon reflexes). The only abnormality found and noted on examination was that the patient had mild anterior weight bearing of the head (i.e., forward head carriage), and the left parietal area appeared very flat. Using the Upledger craniopathic examination protocol, I identified restriction in the normal sacrum and parietal motion patterns.

Clinical Impression

The diagnostic impression was posttraumatic seizures, which are classified as absence seizures, or complex partial seizures with impaired consciousness, or a combination of the two. Absence seizures in the past have sometimes been referred to as petit mal.

Treatment

The patient was treated by first restoring normal sacral motion. This is defined by John E. Upledger (see his Your Inner Physician and You) as a gentle rocking motion that represents the sacrum alternating in a flexion and extension rocking motion, at a rate of 6 to 12 cycles per minute. Next, we restored normal cranial motion, mainly by correcting the loss of parietal motion on the left. In this case, although this is hardly typical of cranial work in general, the patient was able to feel the correction take place. Usually the patient remarks, "I did not feel anything happen," when cranial procedures are performed.'

The patient was treated three more times. Each time, she was checked for normal sacral and cranial motions. She reported that starting with the first visit, she has had no more seizures. She also said that about a month after the initial treatment, while at school, she felt a seizure maybe coming on when she found herself in a room that was about 100 for 45 minutes. When she left the room, the feeling of an imminent seizure passed without ever having become a reality.

Discussion

Posttraumatic seizures are broken down into two groups, depending on onset: within the first five days after head trauma, they are called early posttraumatic, whereas if they occur five days or more after the trauma, they are termed late posttraumatic. Posttraumatic seizures occur in about 4 percent of the people with head trauma. The risk is higher in people who have any of the following associated with their head trauma: amnesia for over 24 hours, depressed skull fracture, dural tear, and focal neurological signs. It is rare for posttraumatic seizures to occur without loss of consciousness. Half of the patients with posttraumatic seizures recover spontaneously within eight years. In about 25 to 30 percent of posttraumatic seizures, the case will be drug-- resistant. These patients need to be followed for two years after the last seizure to ensure that they will not have further seizures. Table 1 lists defining characteristics for the two types of seizures.