seizures

A 78 year old male who is a carpenter , resident of Nalgonda came to OPD with cheif complaints of
    5 episodes of seizures since 9pm on 22/9/2023 .
History of present illness:
Patient was apparently asymptomatic 6 months back then he developed first seizure activity associated with involuntary moments of both upper and lower limbs with involuntary micturition with uprolling of eyeballs and tongue deviation.
H/o dementia present
H/o post ictal confusion 
No H/o frothing during seizures.
History of last seizure:
On 13/9/2023
Past History
H/o head trauma 1 month back
H/o dementia with seizures
H/o Hypertension since 6 months
N/K/C/O DM, thyroid disorders,CAD,Asthma.
Treatment history
He was on medication for hypertension.
Anti epileptic drugs: 
TAB.BREVIPIL 50mg PO/BD initially.
TAB.BREVIPIL 50 mg PO/OD since 5 days
Personal History
Diet :mixed 
Appetite: normal
Sleep: adequate
Bowel and bladder movements: regular
Addictions: alcoholic but stopped 5 years back
NO known allergies.
Family History: not significant.

General examination: 
Patient is conscious,incoherent,uncooperative and not well oriented to time and place.
Patient is examined by taking proper consent in a well lit room.
No pallor
No icterus
No cyanosis 
No clubbing
No pedal odema 
No lymphadenopathy 

Vitals:
Temperature: afebrile 
Bp 130/80
RR 16 cycles /minute
Pulse rate :64/minute
Spo2 : 98%
GRBS: 92 mg%

Systemic Examination
CVS : S1 S2 heard,no thrills and murmurs
RESPIRATORY SYSTEM: B/L air entry present.
Position of trachea -central 
No dypsnea
No wheezing
Breath sounds: vesicular 
ABDOMEN: 
Shape of the abdomen: scaphoid
No tenderness
No palpable mases
No hepatosplenomegaly 
CNS:
Level of consciousness:stuporous
Speech slurred
No signs of meningitis

Sensory system examination

Touch sense- present 
 pressure sensation- present 
Vibration sense -present
Proprioception-intact 

Motor system examination
Bulk -normal 
Tone-normal
Power-.                     Right.                  Left


                       UL     5/5.                       5/5
     
                        LL     5/5.                       5/5

Glasgow scale:normal

Treatment history:

23/09/2023

INJ.LEVIPRIL  500 mg IV
INJ.SODIUM VALPROATE 500 mg IV/BD
INJ.OPTINEURON. 1 ampoule 500ml IV
                             NS/ STAT.
RT FEEDS-100ml milk 4 hrly and 100 ml Water 2 hrly.
TAB.MET-XL 25 mg PO/OD

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