Diagnosis please 9 yrs girl presenting severe and continuous epileptic seizure since 2 hrs afebrile, no h/o trauma, after paxum, epsolin, o2, nebulization , antibiotics. Patient stable now. Please suggest your valuable opinion.



Focal status epilepticus.suggest loading dose of Fosphenytoin 20 mg / kg at a rate of 100mg per mt ( you can give 150 mg / kg ).IF seizures continue another 5mg _per kg Additional dose.Still getting iv Leviteracetam 750 mg stat and continue oral Leviteracetam. DO an EEg. MRI brain. For focal seizures ideal oral med carbamazepine/ oxcarbaz/ levipil.Ideally start with single drug , optimum dose

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Partial seizures involving one side of face. May be a localised lesion in the brain. Since the patient is stable now you can continue the treatment and adv for EEG and CT SCAN OF THE BRAIN. Depending upon the reports treat accordingly. An advice from neurophysician is mandatory

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Focal status epilepticus. Treat in PICU. IV phenytoin 20mgkbw loading dose. Repeat after 10 min if no response ,maintained 5mg KBW every 6 hrs. Get Electrolytes glucose,calcium,treat hypotension,hypo or hyperthermia, maintain hydration,monitor vitals . Once stable investigate CT,MRI EEG. LP if s/s suggestive of infection. Treat with oral Carbamazepine for focal seizures,review after 6mo.

Complex partial seizures .... involving rt face along with loss of consciousness ..... stabilize the patient ABC sequence followed by anti epileptics .. rvaluate for etiology by asking history of fever , family history , trauma , head ache , vomitings, poison ingestion, intra cranial surgeries in past , send inveatigations like cbc , blood sugar , elwctrolytes .. do a lumbar puncture after ruling out raised icp , eeg and mri . Start anti convulsant and other medication according to etiology

She seems conscious

Focal seizure involving face . Continue anticonvulsant n send the patient for CT n eeg . R/o intracranial space occupying lesion like neurocyticercosis.

ADVISABLE..... 1 ). C T. Scanning...... Brain 2 ). E E G...... 3 ). COMPLETE. Blood. Examination .... including. .... Electrolytes.... Proteins.. L F T.....R F T... 4 ). U S G ..... CHEST. and. Whole. Abdomen... 5 ). Tab ALB + Ivermectin. 6 ). Tab. Eptoin.. MANAGEMENT......as. per. REPORTS

Thank. U... Sir Good morning..

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Ask for CT scan of BRAIN and till report come continue Tab Eptoin bd and Tab Albendazole one tab for three days

Thanks Dr Dinesh

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Get a CT scan. Find out if any focal lesion. If positive refer to a neurosurgeon for needful. If CT negative for SOL, continue oral dilantin and follow up.

Partial seizures involving face only, start first line antiepileptics and control seizure first, when stable do EEG and contrast MRI Brain with MRS and treat accordingly

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