24 year old with episode of seizure

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 CHIEF COMPLAINT

• The person in question is 24 years old and lives in Chittyal.
• She is a computer operator at MRDO.
• Her chief complaint is an episode of seizure that occurred at 7 pm one day ago 
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• HISTORY OF PRSENTING ILLNESS 
• She woke up at 6:30 am.
• At 11:00 am, She had breakfast which consisted of rice and chicken.
• At 2 pm, She went about her day as usual since it was Eid
• She prepared food.
• until 3:30 pm, She took a nap.
• Later on, She prepared food 
• blacked out ,attenders noticed sudden involuntarily movements of all four limbs initially stretched her right upper limb and lower limb followed by continuous movement of all four limbs lasting for 3 minutes each ,3 episodes occurring with in the span of one and a half hour
• H/o of loss of coinsciousness
• H/o of deviation of eyes towards right ,absent blink
• H/o of drowsiness for 45 mins followed by which patient woke up and had reduced movement of right upper and lower limb for 1-2 hrs
• During the episode , She had foaming of saline in mouth ,deviation of mouth and shouted aloud(epileptic cry) associated with postictal confusion not associated with lateral tongue bite ,aura,urinary incontinence ,associated paralysis
• Patient complaints of band headache which is dull aching ,continuous more in frontal region not associated with nausea vomitting ,phono/photophobia,tearing of eyes ,blurring of vision ,facial pain ,change in instensitt with movements
• • No h/o fever
  • No H/O rash, photophobia, joint pain/swelling
  • No h/o menstrual irregularities
  • No h/a/o cranial nerve involvement.
  • No h/o previous or current Sensory
    symptoms(positive or negative)
  • No h/s/o motor weakness.
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• PAST HISTORY

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• K/c/o epilepsy .
• In the past, the individual had an episode of seizure.as a
• child
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• During the 10 months of pregnancy, she was admitted to a government hospital as she did not experience any labour pains until she had a seizure at 7:00 pm. The next day, they had a cesarean section, and the baby's birth weight was 4 kgs.male child.
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• 8 months ago she went for a general check-up organised by her office ,was advised to visit without eating breakfast. She completed several tests, including ophthalmology and ultrasound, before eating food and returning to Mrdo.while on duty at 11:00 am experienced an episode of seizure while in the office ,patient doesn’t not remember anything prior and later the episode
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• MENTRUAL HISTORY  
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• She had her first period (menarche) at 14 years old with a 30-day cycle lasting 6-7 days, requiring 2 pads per day with no clots or pain.

• The individual got married at 17 years old in a consanguineous marriage. After 1 year of marriage, they had their first child through spontaneous conception. During the 10 months of pregnancy, they were admitted to a government hospital as she did not experience any labour pains until she had a seizure at 7:00 pm. The next day, they had a cesarean section, and the baby's birth weight was 4 kgs.male child.

  
  

  
  

  Not k/c/o Type 2DM, HT, Tuberculosis.

  previous admissions to the hospital 8 months back when she was advised to take leveritacetam 500mg tablets (twice daily psotprandial)

  
  

  FAMILY HISTORY

  Grandfather suffered from similar complaints

  TREATMENT HISTORY

  leveritacetam 500mg tablets (twice daily postprandial)since 6 months

  
  
  

  
  

  SURGICAL HISTORY

  No surgical history

  PERSONAL HISTORY

  The individual got married at 17 years old in a consanguineous marriage. After 1 year of marriage, they had their first child through spontaneous conception.

  Had her second child 2 years later through spontaneous conception ,delivered at 9(1/2)months of pregnancy ,birth weight of 3.5 kgs girl child

  DIET -mixed

  APPETITE -normal

  BOWEL AND BLADDER -regular

  SLEEP -adqueate

  ADDICTIONS -none

  GENERAL PHYSICAL EXAMINATION

  
  
  
  
  
  
  

  
  

  PROVISIONAL DIAGNOSIS

  GTCS secondary to non compliance to drugs