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What is not?

 Impossible is not a fact, its an opinion 

Epilepsy,Seizure,Convulsions ,Fits

May 15, 2010 by drsalman

Case Sheet

A 40 year old male brought into office by his wife who noticed him having a episode of convulsion during shopping grocery for his home.Patient went to buy food items for his home along with his wife to nearby grocery store when His wife noticed him describing him telling that some car tyres are burning in the grocery store.Then patients body became blue and he fell on the ground followed by brief contractions of his upper and lower limb muscles.During this episode he lost control over his bowel and bladder and also bite his tongue.This episode lasted for about 5 minutes and the patient slowly regained his consciousness over few more minutes.Patient had paralysis of his left upper and lower limb for about 10 minutes post ictally which he regained before arriving to office.Patient is now back to normal and does not complain of any headache ,weakness,tingling,confusion,memory loss,chest pain,palpitations,seating,blurring of vision,Patient cannot describe to him what happened during the episode.He still complains of some muscle pains all over the body.His maternal aunt has history of epilepsy and his father is suffering from CAD,HTN.Patient never had similar complaints in past.Patient is a chronic smoker and works as school van driver.

   On examination patient is right handed with no pallor,icterus,cyanosis,clubbing,pedal edema.

  BP:122/80 mmHg

  PR:78/min

 Temp:97.8 F

  RR:18/minute

       Patient tongue seems to be bitten and his clothes are soiled.

Case Discussion: 

Aura= Abnormal Smell,abnormal taste,unusual behavoiur,automatism

Tonic=Sustained contraction of one or more muscle groups.

Clonic=Rythmic contraction and relaxation of muscles.

Generalised=Involves brain diffusely

Partial=Involves brain discretely

Partial secondary generalised=Starting as partial becoming generalised.

Absence=Transient loss of conscoiusness with loss of postural tone

Myoclonic=Sudden brief contaction

Atonic=Faccid muscle group

Rules: 

Symptoms:

Aura :

Abnormal Smell 60

Abnormal taste 60

Unusual behavoiur 60

Automatisms 60

Dration of Episode:

Less than 1 minute 20

1-10 Minutes   60

Morethan 10 minutes 20

Pallor during episode -10

Facial flushing -10

Crying or talking during episode -20

Cyanosis during episode 50

Tongue bite during episode 60

Bowel or Bladder episode 50

Injury during episode 40

Post ictal cofusion 50

Postictal paralysis 50

Post ictal muscle pain 40

Tonic contactions60

Clonus 60

Transient loss of consciouesness with loss of postural tone 60

Sudden brief contraction 60

Flaccid muscles 60

If Diagnosis generalized epilepsy then give valproate

If Diagnosis Partial then give carbamezepine

In All patients advice avoid driving

In all pateints advice avoid unsafe activities

In all patients advice avoid precipitating factors like Alcohol,Stress,Sleep deprivation,etc.

In Generalized epilepsy alternative drug;levotricetamen.

In partial epilepsy alternative drug:oxcarbezepine.

If epileptic women pregnant then give Folic acid

 

Questions: 

What is the diagnosis?

What is difference between seizure and Epilepsy??

Define Fit and onvulsion??

How do you differentiate  Seizure from Pseudoseizure??

When do you start treatment ??

 

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