Epilepsy Case

Clinical Vignette

Meghan is a 15-year-old girl referred for an evaluation of a first seizure. She had been up at a slumber party the night prior to the event. On the following morning, she had a sudden event consisting of falling to the ground and becoming rigid in all extremities, which was followed by jerking of all extremities. The entire event lasted approximately two minutes, and afterwards she was somnolent and groggy, with gradual regaining of consciousness. And after regaining consciousness, she remained confused and disoriented for approximately 15 minutes.

In hindsight, she has a history of being "spacey" and has often been teased about this.   She is unaware of these episodes, however. her past medical history is unremarkable.  She is product of a normal birth and delivery and had normal milestones. She is a good student in school. Her family history is positive for a maternal cousin with seizures. She takes no medications.

Both general examination and neurologic examinations are normal.

Learning objectives:

  1. What is a seizure? What is epilepsy?

  2. List mimickers of seizures

  3. Understand the International Classification of Seizures?

  4. Why is it important to distinguish between partial-onset and primary generalizedonset?

  5. What seizure types should be considered in the differential diagnosis of this patient's episodes

  6. What other history would help categorize the patient's episodes?

  7. How may diagnostic studies be used to categorize seizure types?

  8. Explain which anticonvulsants are useful for each apecific seizure type.

  9. Define status epilepticus and outline treatment algorithm for status epilepticus.

  10. Explain basic first aid for a seizure episode.