This document contains 10 case studies presented to test knowledge of neurological disorders like epilepsy. The cases include examples of primary generalized epilepsy, secondary generalized epilepsy from focal lesions, and drug-induced seizures. They cover common conditions seen in neurology practice and aim to evaluate ability to synthesize history and exam findings to form differential diagnoses and management plans.

2. If you are on right path and you are not
facing difficulties… then think for a while:
you may be on wrong path…because right
path always contains difficulties.
HAZRAT ALI R.A

3. DR. ARSHAD
RABBANI

4. CASE 1
 A young girl of age 10 is brough to
medical OPD with c/o deteriorating
performance in her studies. According to
her teacher, she stops doing her work &
seems to have day-dreaming. This
happens at home too. No h/o loss of
consciousness or any altered mental
status.
 What may be the possible cause?

5. CASE 2
 A 40 yrs old
gentleman is brought
to ER with h/o
GTCF.patient is
drowsy. there is h/o
low grade fever,
cough & anorexia for
last 1 month. CXR is
shown. Give your
diagnosis.

6. His CT brain is shown

7. CASE 3

A 35 years old lady is brought to ER with
c/o left sided weakness. Pt is slightly
confused & shows features of left UMN
lesion. There is history of epilepsy for
which she takes medicine
continuously.her weakness recovered
within 6 hrs. give your diagnosis.

8. Case 4
 A 67 yrs old man is brought to ER with
H/O focal fits in right arm. There is h/o
some neurosurgical procedure 14 yrs
back. Pt remained well since then.
 What may be the cause?

9. CASE 5
 A 34 yrs old gentleman with history of
epilepsy for last 15 yrs, on regular
treatment presents with c/o multiple
swellings over his body. No h/o fever,
anorexia or weight loss. o/E there is
generalised lymphadenopathy.
 What rare possibility comes to your mind?

10. CASE 6
A 34 yrs old lady comes to gynaecology
OPD with bad obstetric history. There is
h/o 2 abortions & 1 baby with cleft palate.
She is also an epileptic and takes
medicine irregularly/
 What advice should be given to her?


11. CASE 7
 A 13 yrs old boy is brought to ER with c/o
GTCF at home about 30 min back. In ER
again he has an episode of GTCF. He is
given INJ DIAZEPAM 10mg IV. The boy is
mentally retarded. Examination reveals
small white oval lesions on skin. There is
family history of epilepsy.
 What condition comes to your mind?

12. CASE 8
 A 65 yrs old gentleman is brought to OPD
with c/o abnormal movements of right
hand. According to patient, this problem
aggravates when he attempts to write or
perform some skilled work .his uncle also
had similar problem. No other finding in
history and examination.
 What may be the cause?

13. CASE 9
 A 45 yr old diabetic is brought to OPD with
2 days history of difficulty in walking and
inability to hold the objects. O /E:
 Pt is conscious oriented
 There are intention tremors on right side
 Patient falls to right side when asked to
walk.
 What is your diagnosis?

14. CASE 10
A young girl of age 17 is brought to
hospital with c/o difficulty in walking and
increasing clumsiness of hands for last 6
months. o/e a young girl with rapid
involuntary movements of both hands.
She has a broad-based gait. eye
examination reveals a characteristic
lesion. What is your impression?

16. DEFINITION
 Epilepsy is a tendency to have recurrent
seizures. It is a symptom of brain disease
rather than a disease itself.
 A seizure is any clinical event caused by
abnormal electrical discharge in the brain.

17. Seizures types

18. ETIOLOGY

19. Incidence according to age

20.  PRIMARY GENERALISED EPILEPSY
 SECONDARY GENERALISED EPILEPSY
 PARTIAL EPILEPSY

22. 1)
2)
3)
4)
It has four types:
Childhood absence epilepsy
Juvenile absence epilepsy
Juvenile myoclonic epilepsy
GTCS on awakening

23. PRIMARY GENERALISED EPILEPSY
 Onset mostly in childhood or adolescence
 Mostly due to genetic predisposition
without a structural cause
 It comprises upto 10% of all epilepsies
and upto 40% of tonic clonic seizures.

24. It may be caused by:
 Spread of partial seizures due to structural
disease OR
 May be secondary to drugs or metabolic
disorders.
 Epilepsy presenting in adult life is almost
always secondarily generelised.

25. CAUSES OF SECONDARY GENERALISED
EPILEPSY
 secondary
 Inflammatory:
generalisation from
partial seizures
Multiple sclerosis
 Genetic
SLE
 Cerebral birth injury
 Metabolic:
 Alcohol
Hypocalcemia
 Toxins
Hyponatremia
 Infective:
Hypoglycemia
meningitis
Renal failure
Postinfectious
Liver failure
encephalopathy
 Drugs
 Degenerative
disease

26. FOCAL LESIONS IN BRAIN
CAUSING EPILEPSY

27. DRUGS CAUSING SEIZURES
 Penicillin, isoniazid , metronidazole
 Chloroquine, mefloquine
 Ciclosporin
 Lidocaine,
disopyramide
 Amphetamines (withdrawal)
 Psychotropic agents:
phenothiazines, tricyclic antidepressants
lithium

28. 1: IDIOPATHIC
2: FOCAL STRUCTURAL
LESIONS:
 Genetic:
Tuberous sclerosis
Neurofibromatosis
 CVA
 Trauma
 tumours
 Infective:
Cerebral abscess
Toxoplasmosis
Tuberculoma
Subdural empyema
Encephalitis
 Inflammatory:
Sarcoidosis
vasculitis

29.  Sleep deprivation
 Alcohol withdrawal
 Physical & mental exhaustion
 Recreational drug misuse
 Intercurrent infections
 Metabolic disorders
 Flickering lights including TV & computer
 Loud noise, music, hot bath, reading
(uncommon)

30.  EEG
 CT scan brain
 MRI
 TESTS FOR SECONDARY CAUSES:
 RFTs, LFTs , blood glucose, s electrolytes
 CXR
 CP, ESR, CRP,
 CSF examination

32. IMMEDIATE CARE
 FIRST AID BY RELATIVES
 IMMEDIATE MEDICAL ATTENTION:
ENSURE PATENT AIRWAY
GIVE OXYGEN
GIVE IV ANTICONVULSANT
TAKE BLOOD FOR DRUG LEVELS
INVESTIGATE THE CAUSE

34. ANTICONVULSANT DRUGS
 Carbamazepine
 Sodium valproate
 diazepam
 Clonazepam
 Phenytoin
 phenobarbitone
 Topiramate
 Gabapentin
 Lamotrigine
 ethosuximide

35. Guidelines for anticonvulsant
therapy
 Start with one first-line drug.
 Start with low dose & increase to effective
dose.
 If first drug fails, start second drug while
gradually withdrawing first.
 Try three agents singly before using
combination.
 Don’t use more than 2 drugs at a time.

36. Withdrawal of AEDs
 After complete control of seizures for 2-4 yrs,
consider AED withdrawal.
 Childhood epilepsy carries the best prognosis for
successful drug withdrawal.
 Seizures that begin in adult life particularly those
with partial features are likely to recur esp if
there is underlying structural cause.
 Overall recurrence rate after withdrawal is 40%
 Withdrawal should be gradual over 6-12 months.

38. Status epilepticus exists when a series of
seizures occur without the patient
regaining awareness between attacks
over a period of 30 minutes.

39. MANAGEMENT
 GENERAL CARE
 IV line
 Diazepam 10mg IV or rectally, can be repeated
once OR lorazepam 4mg IV
 If seizures continue after 30 minutes :
IV infusion phenytoin or phenobarbital
 If seizures still continue after 30 -60 min:
Intubation & ventilation
 Once status controlled:
Commence longterm anticonvulsant medication

41. EPILEPSY OUTCOME AFTER 20 YRS
 50% seizure free
without drugs for last
5 years
 20% seizure-free for
last 5 years but
continue to take
medication
 30% seizures
continue inspite of
anti-epileptic therapy