26 year old woman with c/o seizures since 5 days

 26 year old woman resident of Lingotom who is unmarried came with c/o involuntary movements of both upper limb and lower limb since 5 days ,drooling of saliva present 

No urinary incontinence, no tongue bite

Patient earlier recalled events dates back when she was 12 years old presented with GTCS (no documentation)

She was having on and off seizure episodes and did not subside for 2 years, she visited many hospitals in that period and later she was taken to hyderabad and was put on antiepileptics and was seizure free for 2 years and then again developed seizures 

She gives a history that she was conscious at the time of seizure episodes and was able to recall the events with no post ictal confusion but sometimes preceeded by aura with involuntary movements of both hands and legs with post ictal confusion lasting for 1-2 min with drooling of saliva

She gives a h/o preceeding fever before seizure episodes 

From the age 16-24 she was having on and off seizure episodes and were not subsided

For the last 3 years she started using tab carbamazepine 200 mg TID with on and off seizure episodes 

On focussing on recent history she had a seizure episode (? Focal ?GTCS) around 7 30 pm on friday 

2 nd episode was on saturday morning 9 am and was seizure free until evening when she developed 5-6 episodes of seizures 

From sunday to wednesday morning her mother gave h/o multiple episodes each lasting for 1-2 min with post ictal confusion for 1-2 min with 15-20 min gap between each episode and presented to casuality for further evaluation 

Patient denies H/o fall ,head trauma,skipping medications

Her mother denies h/o delay in milestones 

She completed her secondary education and was forced to quit studies as she was having recurrent episodes of seizure

She developed 8-10 episodes of ?GTCS episodes from the time of presentation to casuality 

O/E patient is conscious, coherent,cooperative 

Vitals 

Patient is afebrile

Pulse rate :82 bpm

RR: 16 cpm 

BP: 140/90 mm hg 

Spo2 :99%

Grbs: 123 mg/dl

S/E

Cvs: S1 S2 heard 

Rs: BAE present 

Cns: higher mental functions

patient is conscious oriented to time place and person

Speech is normal 

No signs of meningeal irritation 

Cranial nerves intact 

Reflexes  

                          rt                     lt

Biceps               -                       -

Triceps             -                       -

Supinator        -                       -

Knee                  -                       -

Ankle                -                       -


Investigations 


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