Case Study

Epilepsy

INDEX
CONTENTS
History of Patient Diagnostic test Prescribed Drugs Drugs Detail General information First Aid 2 3 4 5 7 8

NAME OF THE PATIENT: - kamal Parshad SEX: -Male AGE: - 45 yrs.

DIAGNOSIS:HI with EDH Left frontal region with depressed fracture frontal bone left side.

HISTORY OF ILLNESS:H/O RSA at around 2pm on 02/02/2012 H/O LOC for about 10-15 minutes Nasal bleed present Oral bleed present Multiple injuries on face and forehead present First aid and suturing outside No H/O ASTHMA/DM/HTN/Drug allergy

EXAMINATION: Patient conscious, drowsy and disoriented Pupils- Right NSRL and left dilated Vitals BP 130/90 Pulse 80 per minute Rhythm rate- 24/minute

Chest NAD Abdomen NAD

INVESTIGATION:CTHP 02/02/2012 EDH left frontal region with depressed fracture frontal bone left side. X-ray chest AP view- NAD ECG- WNL Hb- 11.7 gm Urea- 26.6 Creatinine- 1.03 Blood group- B positive HIV/HCV/Hbs Negative

HOSPITAL COURSE Left frontal craniectomy and removal of fractured bony fragments and removal of underlying EDH done under GA. Patients condition improved. Patient became conscious, talkative, accepting orally, moving about. Discharged on Request in better condition without stitch removal.

CONDITION AT DISCHARGE Patient conscious Well oriented to time, place and person

Irritable Vitals: within normal limits Accepting orally Moving about

TREATMENT ADVISED Tab Eptoin 100 mg Tab Pantocid 40mg Tab Cetil 500 mg Tab Donn-Plus I tab Ciplox eye drops Neomycin eye oint. TDS OD BD TDS TDS TDS

DETAILS OF PRESCRIBED DRUGS

EPTOIN
Dose: - 100 mg (Thrice daily) Indication: - An antiepileptic drug used to control tonic, clonic and partial seizures. ADME: -

Epitoin is slowly and almost completely absorb from GIT. It is largely insoluble at the acid pH of the stomach, most being absorbed from upper intestine and the absorption is affected by presence of food. It is extensively metabolized in the liver to inactive metabolites, chiefly 5(4-hydroxy phenyl)-5-phenylhydantion. It undergoes enterohepatic recycling and is excreted in urine, mainly as its hydroxylated metabolite, in either free or conjugated form. Indications:Control of grand mal and psychomotor seizures. Prevention and treatment of seizures during and following neurosurgery. Treatment of blisters and erosion in epidermolysis bollosa . Drug Interactions:Anticoagulant effect of warfarin may be altered. May reduce the effectiveness of oral contraceptives. Ethosuximide increases its plasma levels. Chloramphenicol increases the serum phenytoin levels causing toxicity. Rifampicin decreases the serum phenytoin levels. Cyclosporine levels in the blood may be reduced. Contraindications:AV Block Side effects:Lupus erythematous, Stevens-Johnson Syndrome or phenytoin hypersensitivity syndrome which may be manifested by (rash, local or generalized lymphadenopathy, hepatitis or nephritis), tenderness and hyperplasia of the gums particularly in younger patients, lack of appetite, nausea, vomiting, constipation, headache, dizziness, insomnia, hirsutism, agranulocytosis, thrombocytopenia, folic acid deficiency. C.N.S toxicity (Nystagmus, confusion, mood or mental changes, increased frequency of seizures, slurring of speech, trembling of hands, nervousness and irritability) usually with long-term use, but may be dose-related.

PANTOCID

It is a proton pump inhibitor i.e It inhibitsspecifically and dose proportionally the gastric Hydrogen ion, Potassion- ATPase enzyme which is responsible for acid secretion in the parietal cells of the stomach. Indications: For the symptomatic improvement and healing of gastrointestinal diseases which require a reduction in acid secretion, e.g. Duodenal ulcer, gastric ulcer. Moderate and severe reflux oesophagus. Contradictions: Hypersenstivity to any of the constituents. Side effects: Headache or diarrhea. Rarely skin rashes, pruritis and dizziness.

CIPROFLOXACIN

A fluoroquinolone antimicrobial agent wit potent activity against a broad spectrum of gram-positive and gram-negative bacteria including. acruginosa, Enterobacteriaceae and Staph aureus. Ciprofloxacin does not disturb normal anaerobic intestinal flora and, has significant post-antibiotic effect and thus prevents regrowth of bacteria. Its antibacterial apectrum is wider than that of aminoglycosides, third generation cephalosporins and other fluoroquinolones. Indications: Respiratory tract, urinary tract, ENT, skin and soft tissue. GI tract, Intra-abdominal gynaecological. Bone and joint and severe systemic infections. Gonorrhoea.

Contra-indications: Hypersensitivity to ciprofloxacin or any other quinolone derivative. Not recommended for use in children and adolscents. Side effects: Diarrhoea, vomiting, abdominal pain, headache, restlessness and arthalgia.

Drug-interactions: Magnesium, aluminium calcium, iron and zinc, antacids decreases ciprofloxacin absorption. Potentiates oral anticoagulants. rifampicin reduces serum concentration of ciprofloxacin. CNS excitation occur with concurrent administration of quinolones and NSAIDs.

PARACETAMOL
Paracetamol is a valuable central analgesic but weak peripheral anti-inflammatory agent and exhibits good and prompt antipyretic action. It does not stimulate respiration or alter acid base balance and causes less gastric irritation and have no effect on cellular metabolism or clothing factors. It is not uricosoric. Indications: Pain, fever Side-effects: Nausea, rashes, leukopenia is rare Drug-interactions: Enhances oral anticoagulant activity. Absorption increased by metaclopramide. Absorption reduced by pethidine, propanthine. Alcohol (chronic use) potentiates hepatotoxicity by paracetamol.

GENERAL INFORMATION
An accurate diagnosis of the type of epilepsy is very important in choosing the best treatment. The type of medication prescribed will also depend on several factors specific to each patient, such as which side effects can be tolerated by the patient, other illnesses they may have, and which delivery method is acceptable. Here list of some of the most common drugs currently used to treat epilepsy. There is no known cure for epilepsy. But medications can control seizures in most people. These medicines do not actually "fix" the problems that cause seizures. Instead, they work by stopping the seizures from occurring. Before suggesting treatment with a seizure medicine (also called an antiepileptic drug or AED), your doctor usually has made a diagnosis of epilepsy. It is important to openly discuss with your doctor the pros and cons of the different medicines that are available to treat your kind of epilepsy.

Drugs which we can also prescribed for partial seizure :-

TegretolFirst choice for partial. Due to large number of side effects of Epitoin ,Tegretol would have been given as the side effects of thus drug are quite less as compared to Epitoin that are fatigue, vision changes, nausea, dizziness, rash. Gabitril Used with other epilepsy drugs to treat partial and some generalized seizures. Common side effects include dizziness, fatigue, weakness.. Keppra Used withother epilepsy drugs to treat partial seizures.This drug would have taken the place of Epitoin as it has very mild side effects such as tiredness, weakness, and behavioral changes Lyrica Used to treat partial seizures.Side effects include dizziness, sleepiness (somnolence), dry mouth, peripheral edema, blurred vision, weight gain, and difficulty with concentration/attention. Topamax Used with other drugs to treat partial seizures. Side effects are less than epitoin. Trileptal Treats partial seizures. Most common side effects are tiredness, dizziness, headache. VitaminD may help people with epilepsy by: Increasing low bone mass density Protecting against diseases that are risk factors for epilepsy Low bone mass is a problem for people with epilepsy, which may increase the risk of fractures associated with falls.

FIRST AID
With this type of seizure the person may appear unresponsive and confused. Automatic movements such as smacking of the lips, wandering, or fumbling movements of the hand may be present. He or she may display inappropriate behaviour that may be mistaken for alcohol or drug intoxication.

Things To Remember:Although partial seizures affect different physical, emotional, or sensory functions of the brain, they have some things in common:

 They dont last long. Most last only a minute or two, although people may be confused and need a lot more time afterwards to recover fully. They end naturally. Except in rare cases, the brain has its own way of bringing the seizure safely to an end after a minute or two. You cant stop them. In an emergency, doctors may use drugs to bring a lengthy, non-stop seizure to an end. However, the average person cant do anything except wait for the seizure to run its course and try to protect the person from harm while consciousness is clouded. They are not dangerous to others. The movements produced by a seizure are almost always too vague, too unorganized, and too confused to threaten the safety of anyone else. Handling Partial Seizures:Simple partial seizures dont require any special response except to recognize whats happening and be supportive until the seizure is over. For complex partial seizures, the following steps may help: Reassure others. Explain that any unusual behaviour is a temporary condition brought on by a seizure and that it will end in a few minutes. Remove hazards or anything that might injure someone who doesnt know where he is or what hes doing. Dont restrain the person during a complex partial seizure, especially if he is already agitated or confused. Efforts to restrain may produce an unconscious aggressive response. Guide gently away from anything that could be dangerous, like an open fire or a busy street. Stay back until the episode has ended if the person appears obviously agitated or belligerent. Be reassuring and helpful as awareness returns. Remember that people may get back their ability and understand before they speak again. Confusion, depression, agitation, irritability, belligerence, or drowsiness are all possible aftereffects of seizures. Watch the time. Most partial seizures last a minute or two. But people may feel confused for up to half an hour afterwards. Longer periods of confusion may mean that seizure activity is continuing and the person needs medical help. First aid or partial seizures:During a partial seizure you may need to gently guide the person past obstacles and away from dangerous places. As the seizure finishes, establish supportive communication and ask if they are OK. Call an ambulance if the person doesnt start to recover after 5 minutes.

Living with Partial Seizures:As weve seen, partial seizures take many forms and medical treatment does not always control them. People who live with frequent complex partial seizures may face many challenges. One involves personal safety. Things like fire, hat, water, heights, certain machinery, and sharp objects are all potential hazards when people are unaware of what theyre doing and dont feel pain. However, there may be ways to reduce obvious risks. For example: Using a microwave oven for cooking instead of a gas or electric range. Taking plates to the oven or the stove to serve oneself to avoid having to carry pans of hot food or liquid. Using a regular knife for carving, not an electric knife or, if possible, leaving the carving to someone else. Keeping electric mixers and other electric appliances far away from the sink or source of water. Setting the water heater low enough to prevent scalding during a seizure and taking sit down showers if drop attacks are frequent. Making sure open fires have guards and that electric or other space heaters cant be tipped over. Not smoking and not carrying lighted candles or hot ashes from the fireplace through the house. Padding sharp corners and carpeting floors.