Case 18.5Episode of staring, lip smacking, and unilateral

semi purposeful movements

C2Llamas- Macalma

Case Protocol

• 26 year old • right handed woman• product of normal birth and delivery• consulted at epilepsy referral center for evaluation of

medically refractory seizures

HISTORY OF PRESENT ILLNESS9 months of age had 2 prolonged febrile seizures in one day.. She was

treated with anti-convulsants which initially stopped the seizures.

She began to have stereotyped episodes that continued to adulthood and were refractory to multiple medications.

Episodes begin with an aura of a “vague” and “scary feeling” followed by loss of awareness.

Her mother described her seizures as next having staring , unresponsiveness, lip smacking, rigid posturing of the left arm, and groping, purposeless movements of

the right arm lasting about a minute.

HISTORY OF PRESENT ILLNESSSometimes she spoke during episodes without grammatical errors but

what she said was inappropriate for the questions being asked.

Post-ictally she was fatigued and somewhat confused but had no other deficits (2-3x per week; 3x day). She had occasional isolated auras, without progression

to full blown episodes.

Her longest seizure free interval in adulthood was about 3months . Rarely (at intervals of greater than 3-5years), mostly in the setting of missing her

medications, she had an episode that progressed to generalized convulsion.

HISTORY OF PRESENT ILLNESS

Medications such as phenobarbital, phenytion, carbamazepine, mephobarbital, valproate, gabapentin, and felbamate were tried in various combinations without effective seizure control.

She had no other seizure risk factors such as head injury, CNS infections, family history of seizure, aside from the febrile seizure.

She graduated from HS, worked briefly as a cashier, was married and had three children. She was unable to drive because of her seizure risk.

Physical exam and neurologic exam were normal.

SALIENT FEATURES

• Pa gawa nlng toh ^_^ and paki check pla hx kung tngn nyu may kailangan edit feel free! Tapos nag ddownload ako ng mga videos ng infants having seizure pwde ntn play for the hx.. Para additional points if ever.. Haha.. =p

LATERLIZED, LOCALIZED, LEVELIZED

• Jo, text mo lang kami if anu pa kulang mo dito ha! ^_^ goodluck sa Monday! Thanks for volunteering as a reporter!! Explain lang nman how to ata di mo ata kailngan daw trace kung anu ung satin.. Pero para safe LLL na din ntn! ^_^