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Abstract: The patient, a 17-year-old male, was found by his family in bed at 7:00 a.m. with twitching limbs, closed teeth, and upturned eyes, and was unable to wake up even after screaming, so he was rushed to the hospital by calling 120. He was diagnosed with seizures after completion of MRI and EEG. He was kept in the emergency room for 3 days under sedation with diazepam injection, sodium phenobarbital for injection, and oxygen therapy.
Basic information】Male, 17 years old
Type of disease】Seizure
Hospital】Shandong Provincial Third Hospital
Date of consultation】July 2021
Treatment plan】Intravenous medication (diazepam injection sedation + injectable phenobarbital sodium) + oxygen for 30 minutes
Treatment period】3 days in the emergency room, 15 days after outpatient follow-up
Treatment effect】Stable condition, no recurrence of seizures
I. Initial consultation
The patient was brought to the hospital by her family in the morning. When she came to the hospital, her family cried that she heard some movement in the room at 7:00 a.m. today and found the patient in bed with twitching limbs, clenching teeth, rolling eyes and foaming at the mouth. When he arrived at the hospital, the convulsions were reduced, but he was unconscious, could not wake up, and had recently stayed up late at night playing games. Combined with the clinical symptoms of the patient’s seizures, it was recommended to improve intracranial related examinations. The outpatient diagnosis was considered as seizures and intracerebral diseases needed to be excluded, and the family expressed understanding and actively cooperated with the examination.
II. Treatment history
The patient’s blood tests were completed at the emergency clinic, including routine blood tests, liver and kidney functions, ion, lipids, blood glucose, blood gas analysis, and trace elements tests. The examination results showed high blood glucose and lipid, high leukocyte (stress elevation was not excluded), and no other significant abnormalities were seen. The perfect cranial magnetic resonance examination showed no significant abnormalities, and the perfect dynamic EEG examination suggested the presence of extensive sharp waves in the bilateral cerebral hemispheres, suggesting abnormal EEG. After admission, the patient was given diazepam injection injection for sedation, sodium phenobarbital for injection for antispasmodic, oxygen for 30 minutes and then the patient fell asleep quietly and resumed wakefulness on the second day.
III. Treatment effect
After admission, the patient was given diazepam injection for sedation and sodium phenobarbital for injection for antispasmodic, and after oxygen inhalation, the patient fell asleep quietly and resumed wakefulness on the second day, and was kept in the emergency room for 3 days. However, given that this was the first seizure, it was recommended to observe the patient for 6 months without long-term medication if no further seizures occurred, and if more than 2 seizures occurred within 6 months, long-term oral antiepileptic medication was required. The patient was seen again in 15 days at the outpatient clinic, indicating no special discomfort and no seizures.
IV. Precautions
We are glad that after treatment, the patient did not have any further seizures, but 6 months observation is needed. Regular follow-up visits to the neurology department are recommended to draw blood for routine blood tests, liver and kidney functions, and to improve EEG to assess the intracerebral condition. In daily life, you should ensure good sleep, rest on time, avoid staying up late, exertion, emotional excitement, etc. Observe for dizziness, headache, limb aches, etc. You need to rule out the possibility of occult seizures.
V. Personal insight
Seizures can lead to transient synchronized abnormal discharges in the brain, which can cause ischemia and hypoxia in brain cells, and long-term recurrent seizures may lead to brain parenchymal damage. Patients in this case can relax appropriately in their daily study life, but should not overindulge. They should ensure good sleep and exercise every day, and can achieve relaxation through outings and outdoor sports. When doctors see such patients, they should improve relevant examinations to exclude organic lesions and avoid missing the diagnosis.