Case Study 11: Seizure Disorder
Patient History
A 34-year-old male, Mr. J.S., presents to the emergency department (ED) with a history of recurrent seizures. He reports his first seizure occurred 6 months ago, with 3 additional episodes since then. He has no history of head trauma, stroke, or substance abuse. Family history is negative for epilepsy. He smokes 1 pack of cigarettes per day (ppd) and drinks alcohol socially.
Clinical Presentation
In the ED, Mr. J.S. experienced a generalized tonic-clonic seizure lasting 2 minutes, witnessed by staff. Postictal confusion lasted 10 minutes. Vital signs: BP 140/90 mmHg, HR 98 bpm, RR 18/min, T 37°C. Physical exam revealed no focal neurologic deficits. He reports fatigue and memory difficulties over the past month.
Laboratory Findings
CBC: WBC 8.5 x 10³/µL, Hb 14 g/dL, Hct 42%, Platelets 250 x 10³/µL.
Electrolytes: Na 138 mEq/L, K 4.0 mEq/L, Cl 100 mEq/L, HCO₃ 24 mEq/L.
EEG: Abnormal with epileptiform discharges.
CT head: Normal, no mass or bleed.
Diagnosis
Based on history, clinical presentation, and EEG findings, Mr. J.S. is diagnosed with epilepsy, likely idiopathic generalized epilepsy.
Management Options
Initiate antiepileptic drug (AED) therapy with levetiracetam 500 mg BID. Educate patient on seizure precautions (e.g., no driving). Schedule follow-up EEG and neurology consult in 1 month.
Case Study : A Young Man’s Battle with Seizures
Patient History
Meet James, a 34-year-old graphic designer who’s been having a rough time lately. Six months ago, he had his first seizure out of the blue—right in the middle of a deadline. Since then, he’s had three more, leaving him shaken and unsure what’s going on. He’s never hit his head or had a stroke, and epilepsy doesn’t run in his family. James admits to smoking a pack a day to cope with stress and enjoys a beer or two with friends on weekends.
Clinical Presentation
James landed in the ER after a scary episode at home. The staff watched him go through a full-body seizure—stiffening and shaking for about 2 minutes. Afterward, he was dazed and confused for another 10 minutes, struggling to figure out where he was. His blood pressure was a bit high at 140/90, his heart was racing at 98 beats per minute, and he was breathing 18 times a minute, but his temperature was normal at 37°C. The doctors checked him over and didn’t find any obvious weak spots in his nerves or muscles. James mentioned he’s been feeling wiped out and forgetting little things lately, like where he parked his car.
Laboratory Findings
The team ran some tests to get a clearer picture. His blood counts were solid: white cells at 8.5, hemoglobin at 14, hematocrit at 42%, and platelets at 250—all normal. His electrolytes checked out too: sodium 138, potassium 4.0, chloride 100, and bicarbonate 24. The big clue came from an EEG, which showed funky electrical spikes in his brain—classic signs of a seizure disorder. A CT scan of his head didn’t show any tumors or bleeding, which was a relief.
Diagnosis
Putting it all together—James’s story, the seizure they saw, and those EEG spikes—the doctors figured he’s got epilepsy. They think it’s the kind that just happens without an obvious trigger, called idiopathic generalized epilepsy.
Management Options
To get things under control, they started James on a medication called levetiracetam—500 mg twice a day—to calm his brain down. They also sat him down to talk about safety: no driving for now, and maybe skipping that late-night swim. They booked him for a follow-up EEG and a chat with a neurologist in a month to see how he’s doing.
