SGD B.8 / LT Day 2nd [SEIZURES AND FEBRILE SEIZURES] | Neuroscience Clinical

Case 21. What is the diagnosis of the patients?

The diagnosis above should be done based on several type such as further anamnesis, to know the quantity of seizure in one year, to know the chronology of seizure , onset, the quality of seizure, aggregating factor, also family history, social history such alcoholic status, and the medication that the patient already take before, the diagnosis also should done based on the general physical examination to find any sign of disease/disorder that related to convulsion such as head injury, infection, congenital, even cancer on the brain, EEG examination, MRI (if needed), and laboratory examination to support the etiology of convulsion. But based on data above we just could take first diagnosis (temporary diagnosis) that is general convulsion.

2. Why the pregnancy can induced seizures/convulsion?Because in pregnant women there are many physiological changes in her body. One of them is the increased renal function characterized by an increase in creatinine clearance about 50%, that will reduce levels of Anti-Epileptic Drugs (AED) in the blood circulation, so that will increases the need AED in pregnant woman. In addition, the hormone estrogen is epileptogenic. These hormones increase during pregnancy and reached a peak in the third trimester. So this is the cause of seizure (the stimulus is higher than miokloni threshold), specially in the last trimester.

3. What kind of the drugs you can give to the patients?The drug that we can give to the patient is Fenobarbital (100-300 mgr/day), because the teratogenic of this drug is less than other Anti Epileptic Drugs. This Anti Epileptic Drug (AED) is also cheaper than other AEDs and widely used. We avoid the drug that caused congenital abnormality/teratogenic such as phenytoin, or valproat acid, the drug that indicate dangerous for the infant such as carebamazepine, divalpoex.

Case 31. When you conclusion hemipharesis in this patients?

We can conclude the patient get hemipharesis, if there is weakness or paralyzed on only one side of the body. In this case, hemipharesis is happened on right side. Hemipharesis could be taken based on the clinical finding after the convulsion, whether any weakness of one side body of patient. This finding may refer to Todd’s paralyse or hemiplegia post convulsif, and help to state the topical, focus epileptogenik in cerebri cortex.

2. How you differential diagnosed hemipharesis doe to organic lesion in the brain?Usually the hemipharesis doe to organic lession in the brain started with fever, even sefalgia chronically, the genertic predisposisition minor state, the onset of convulsion is prolonged, the type of convulsion usually general convulsion, and the EEG show abnormality throught out febrile episode. Other differential diagnosis are syncope, migraine, cataplexy, hysteria, hypo/hyperglycaemia, drop attack and converse reaction.

Where the topical diagnosis the patients with hemipharesis on right side?The lesion is in capsula interna or hal hemisphere of cortex cerebri.

3. How to manage the patients who had hemipharesis after seizures?The patient who suffering from hemipharesis after seizure from pure seizure without any brain lesion usually will disappear in 24 hour. We just monitor the patient, such as general status such as blood glucose, electrolite imbalance, respiratory rate, heart rate, blood pressure, to prevent further seizure. We also search the etiology and topical of seizure, such lesion cause by tumor, hemmorage, or another cause that manifest hemiparesis seizure, we can conduct radiologic imaging examination even lab. test ( CBC, ESR, CpK Serum). After we know the diagnosis, then we manage the patient, when the patient suffering from brain lession, manage the etiology.

Neuroscience and Neurological Disorder| Medical Faculty – Udayana University 2012 SGD B.8