Epilepsy
INTRODUCTION
Aizi
is a 5 year-old Indian girl with a history of refractory epilepsies and cerebral
palsy now presenting with an epileptic attack lasting no more than 10 minutes.
HISTORY
Presenting
complaint
The
fits started at 3pm with orofacial grimacing, twitching of eyebrows, rolling
back of eyes, followed by drooling and jerky movements of all four limbs. Her
mother noticed that her face was flushed half an hour before the onset. She
administered rectal diazepam immediately. The fits subsided after 10 minutes and
Aizi went to sleep.
Past
medical
Aizi
was diagnosed to have cerebral palsy with refractory seizures at 3 months old
and was last admitted on 27 May for breakthrough seizure. She used to have 7 to
8 episodes of fits a day. Since commencing on anticonvulsants, the frequency
gradually decreases to the present 3 to 4 episodes of fits a month. The fits are
usually triggered off by a viral upper respiratory tract infection or emotion.
The prodromal symptoms, if present, consists of either flushing of face or
screams. No aura is noted. The episodes are similar to the present one,
consisting of some or all of the following features: orofacial grimacing,
twitching of eyebrows, rolling back of eyes, drooling and jerky movements of the
limbs and they usually last between 5 to 10 minutes. There is no particular time
of occurrence of the fits. The postictal events are sleeping, confusion or
Todd�s paralysis. Aizi is currently on sodium valproate at 50mg, twice a day,
up from the original 45mg when she first started at one years of age as her fits
are refractory to the treatment. Side effects of the medication are loss of
appetite and lethargy. Aizi�s mother was told by doctors to administer rectal
diazepam during each episode of fits. Hospital admission was required if the
fits last more than 5 minutes. Aizi lives in Telok Blangah and it takes at most
20 minutes to travel to NUH. Aizi�s mother knew that Aizi�s seizures are
refractory to treatment and chance of a complete remission is low. Aizi is
currently attending school at Margaret Drive�s Special school. Her attendance
is frequently interrupted by her episodes of fits.
Birth
and development
Aizi
was a premature baby at 34 weeks and was delivered by normal vaginal delivery.
She was diagnosed to have congenital hypothyroidism due to a lingual thyroid and
has since been on thyroxine. Her birth weight is 2.1kg. She was breast-fed for
one month. Immunization schedule is followed accordingly. Her development was
delayed. She is still unable to walk and not able to understand or talk.
PHYSICAL
EXAMINATION
Aizi
is well, comfortable at rest, but unable to respond to speech. She has no
dysmorphic features. Her weight, height and OFC are with 50th and 75 percentile
of her age. Her vital signs are stable. There are no skin rashes. She is moving
all 4 limbs actively and was agitated when examined.