20 yr old male with involuntary upper and lower limb (seizures)
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Chief complaints :
A 20 year old male came to casualty with chief complaints of 4-5 episodes of involuntary movements of upper and lower limbs from 4am in the morning today (19-07-23).
Today's episode:
4 -5 episodes today, involuntary UL and LL movements for 2 to 3 minutes with uprolling of eyes and froathing mouth no involuntary micuturation or passing of stools.post ictal confusion present for 10 minutes
History of present illness:
Patient was apparently normal till 7 years of age, he then had an episode of involuntary movements of upper and lower limbs with up rolling of eye lids and froth from mouth. Each episode lasts for 1-2 minutes.
He was then taken to a hospital where he was diagnosed as a case of epilepsy and put on treatment. Post ictal confusion +ve.
Patient was having seizure episode in every 1-2 months and relieved by themselves.
According to parents, the intensity of each attack is increasing from past one year.
Last seizure episode was 6-7 months back.
No h/o vomitings, involuntary passage of urine or stools.
Past history :
Patient has h/o delayed milestones.
Patient is k/c/o epilepsy since the age of 7 years (13 years) and medication given was Tab. Sodium valproate 500mg PO/OD, Tab. Oxcarbazepine 450mg BD, Tab. Phenytoin 100mg OD.
Not a k/c/o DM, TB, HTN, asthma, CAD.
DETAILS OF SEIZURES ACTIVITY:
9 months pregnancy - no movements present didn't have labour pain
LSCS done didn't cry ? seizures @8th day in NICU (doctor explianed that baby will will have delayed milestones)
AGE OF 6 MONTHS :
Fever with seizure advised to use antiepileptic for 3 yrs but used only for 6months.
Age 7 yrs:
H/O Fall from bed associated with absent seizure which continued for next 6 months till 9yrs of age.
Age 9yrs:
2-3 seizures every 1 month
Age 10yrs:
Absent seizures later followed by generalised seizures
Age 13 to 19 yrs
Seizure activity for every 1 month
Bending knees while walking
Age 19.5
Admission in kims for seizure activity
Age 20yrs
A gap of 6months present from previous activity
MILESTONE EVENTS DELAYED
GROSS MOTOR
3 months :lifts head by 5 months
6 months: tripod postion by 8-9 Monty
12 months:14-15 months standing and walking
walking without support @3yrs
3 years:3and half years he started running
5years:5 and 1/2 he started walking up the stairs
FINE MOTOR
3 months: gripping and grasping @ 6 months
2-3 yrs stacking blocks delayed by 2-3 months
SOCIAL AND ADAPTIVE MILESTONES
6 months: couldn't get scared by strangers
9 months: @1 yr couldn't say bye bye
1year: couldn't play
18 months: copies parents tasks
2years :ask for food drinks
3 yrs: could tell his full name and gender
5yrs: could help in household tasks but couldn't dress and undress
SPEECH DELAYED:key language milestones all on time except mono and bisyllable words delayed
Examination:
Patient is conscious and oriented
PR:68 bpm
BP:120/80 mmHg
RR:18 cpm
RS:BAE+ no added sounds
CVS: s1 and s2 heard no added sounds
Per abdomen:soft and non tener
Pupils:NSRL
GCS:15/15
UL. LL
Tone R. N. N
L. N. N
Power R. 5/5. 5/5
L 5/5. 5/5
Chest x ray PA view
ECG
Previous MRI report 2019
Serum electrolytes
LFT
heamogram
Treatment:
1.tab sodium valproate 500 mg po/od
2.tab oxcarbamazepine450 mg po/bd
3.tab phenytoin 100 mg po/od
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