Seizure Disorder

A case of Tonic convulsion. Chief Complaints A 19 yr old male has come with complains of abnormal stretching of fingers starting from left hand and progressing to right hand involving whole body for past 10 yrs which has progressed over several years to more frequent episodes. Initially it started while exercise now it gets activated even after standing from sitting position. No associated LOC, vomiting, tongue bite, froathing of mouth, urine or stool incontinence headache etc. No H/o head trauma, family history or any susceptible birth history. He has normal IQ and good mental status pursuing Btech. No H/O HTN T2DM, thyroid disoder, substance abuse or any other history. He has normal mental status, normal Motor, sensory, cranial nerve, spine and cranium, cerebellar function. I have advised for MRI brain and EEG and other metabolic profiles.. Waiting for reports. His both MRI Brain and EEG are normal. Investigations https://youtu.be/2q0pUbG4n8U

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The discription is suggestive of paroxysmal kinesiogenic choreoathetosis.Is a type of seizure -movement induced.There is controversy also regarding seizure and movement disorder.More for seizure,stimulation supplementary motor area( area 6) can induce same type of movements Phenytoin is the drug of choice,start with 100mg twice daily.

Thanks a lot mam.
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He appears to be a c/o vit d and vitb12 deficiency and should be supplemented Muscle cramps are likely due to excessive lactic acidosis due to excessive exercise Also go for ck-mb Crp esr and sr creatinine and bul R/o rhobdomyelosis

Sir his CK MB level is normal.. Can rhabdomylosis continue for so long time.. Mere standing can cause lactic acidosis??
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Left focal seizure Diagnosis mainly by clinical Normal eeg/mri can't rule in or rule out epilepsy..!! Must be evaluated by neurologist/epileptologist If required long term video eeg to record seizure

Sir pt was evaluated at SGPGI.. Sir the seizure is involving whole body.. And every time it starts in one limb and proceed to other limbs.. And it's for a fraction of minute.. We are giving him levera and shelcal.
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A video of the episode of the movement disorder will be useful, since all results are normal, except low vitD3

Sir video link is provided..
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