blindsideflank
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had an interesting call the other day and I thought I'd run it past you guys for some opinions.
18 yr old male with down's syndrome and seizure HX since age of 13 (a seizure every few days).
We were called for a seizure and en route dispatch sent police because the last call to that house resulted in a combative patient requiring sedation.
Arrive to pt laying on couch GCS 15 (well he is non verbal but was his normal self). Mom was really worked up which was surprising since he has such a long seizure history. After a bit of time it was apparent we were called not for the seizure but because before and after his seizures he is violent and will hit and bite his mother (acting very differrently from his normal self).
The patient began seizing on us. It was a focal seizure with hand clenching/relaxing and a decreased level on conciousness but his eyes appeared to be tracking and he was breathing well. He seemed aware of the situation and there was no rush to treat this. His mother stated that these go on for an hour.
His other history included being weaned off of a drug a week prior, used to treat focal seizures (ill try to dig up the name) with a resultant increase in frequency of these seizures since. MOM said she asked the doc to take him off the med cuz it makes him more violent.
While listening to a podcast two days ago on comas from emergency medicine cases (soon to be free downloads!!!) they discussed non-convulsive status epilepticus. He mentioned a patient that walked in with family and seemed like a prick, not wanting to answer questions properly and being rude. This turned out to be a status seizure and once treated the patient was back to her regular self.
I was wondering if the violence followed by a focal seizure followed by violence was a possible progression of a seizure and this has nothing to do with pre/postictal states. I don't know what progression the seiziure would be going through to affect the personality then motor then personality.
Anyways, after looking this up I thought I would share it because it is one of those trendy diagnoses that people are going to be looking at because it was misunderstood in the past and some docs are taking the initiative to push this to the forefront. (ie: excited delerium)
18 yr old male with down's syndrome and seizure HX since age of 13 (a seizure every few days).
We were called for a seizure and en route dispatch sent police because the last call to that house resulted in a combative patient requiring sedation.
Arrive to pt laying on couch GCS 15 (well he is non verbal but was his normal self). Mom was really worked up which was surprising since he has such a long seizure history. After a bit of time it was apparent we were called not for the seizure but because before and after his seizures he is violent and will hit and bite his mother (acting very differrently from his normal self).
The patient began seizing on us. It was a focal seizure with hand clenching/relaxing and a decreased level on conciousness but his eyes appeared to be tracking and he was breathing well. He seemed aware of the situation and there was no rush to treat this. His mother stated that these go on for an hour.
His other history included being weaned off of a drug a week prior, used to treat focal seizures (ill try to dig up the name) with a resultant increase in frequency of these seizures since. MOM said she asked the doc to take him off the med cuz it makes him more violent.
While listening to a podcast two days ago on comas from emergency medicine cases (soon to be free downloads!!!) they discussed non-convulsive status epilepticus. He mentioned a patient that walked in with family and seemed like a prick, not wanting to answer questions properly and being rude. This turned out to be a status seizure and once treated the patient was back to her regular self.
I was wondering if the violence followed by a focal seizure followed by violence was a possible progression of a seizure and this has nothing to do with pre/postictal states. I don't know what progression the seiziure would be going through to affect the personality then motor then personality.
Anyways, after looking this up I thought I would share it because it is one of those trendy diagnoses that people are going to be looking at because it was misunderstood in the past and some docs are taking the initiative to push this to the forefront. (ie: excited delerium)
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