Hassan M.

AlShehri
251040006
Case:
 32 yr male
 Episode of epileptic fit that’s proceeded by vague symptom,
his body became rigid (1m)
 He bit his tongue and fell down, which caused minor
injuries.
 Their was also urine incontinence.
 This was followed by phase of convulsion and muscles
jerking with frothing at the mouth (1m)
 Then he fell in deep sleep for several hours.
Px: -ve

EEG: Generalized spike and wave activity.

Dx:
Generalized tonic-clonic (grnd mal) seizure
Pathophysiology:
Seizure: abnormal discharge of electrical activity within the
brain. It is a rapidly evolving disturbance of brain function
that may produce impaired consciousness, abnormalities of
sensation or mental function or convulsive movements.

Epilepsy: a tendency to have seizures and is a symptom of

brain disease rather than disease it self.

The inhibitory transmitter gamma –amminobutyric (GABA) is

particularly important, and drugs that block GABA receptor
provoke seizures.
Classification of Epilepsy:
A) Partial:
Simple-partial (no impairment of conscious)
Complex-partial(impairment of conscious)
Partial evolving to generalized seizure.

B) Generalized:
Absence (petit mal)
Myoclonic
Tonic-clonic (grand mal)
Atonic seizures.
Phases of Tonic-Clonic
Seizure
Prodromal: hours or days before the attack.
Unease, irritability.
Aura: These are specific feeling and patient
anticipate seizure will occur. Olfactory
hallucination, epigastric discomfort, déjà vu.
Tonic phase: 10-20 seconds – muscle
contraction
respiratory spasm causes epileptic cry
Clonic phase:1/2 -2 minutes – violent jerking of
face and limbs, tongue biting and incontinence.
Post-ictal phase: few minutes to several hours
– deep unconsciousness.
Diffrential of Seizures:
 Brain abscesses and Tumors
 Chronic hepatic and renal failure
 Eclampsia
 Encephalitis
 idiopathic
 Hypoglycemia, hyponatremia nd and hypoparathyroidism.
 Stroke
 Arsenic poisoning
 Barbiturate withdrawal
 Drugs: Toxic blood levels of some drugs, such as theophylline,
lidocaine, meperidine, penicillins, and cimetidine, may cause
generalized seizures. Phenothiazines, tricyclic antidepressants,
amphetamines and isoniazid may cause seizures in patients with
preexisting epilepsy.
Problem List:
Minor injuries due to falling and biting his
tongue.
Generalized tonic-clonic seizure
Therapeutic Objectives:
Taking care of his minor injuries
Prevent any further seizures.
 Antiepileptic agents:
Drug Efficacy Safty Suitabilit Cost Total
Phenytoin ++++ ++ y
+++ ++ 11
Carbamazepi ++++ +++ +++ ++ 12
ne
Valproate +++ +++ ++ + 9
Barbiturates +++ ++ +++ +++ 11
Ethosuximide + +++ + ++ 7

P. Drug : Carbamazepine
Prescription:
Patient Name: XXXXX Sex: Male
Age: 32 MR: XXXXX
Date: 27/12/2008

Dx:
Tonic-clonic seizure

Rx:
Tegretol 100mg tablet
Take one tablet PO once daily

Doctor: Hassan M. AlShehri

Signature : 251040006
Instructions:
Patient and family education about the
disease
Patients should not drive, swim unsupervised,
bathe in a bathtub of standing water, or be in
position to fall from heights during a seizure.
Explain possible side effects of medication

Follow up
Thank You