somatosensory seizures

INTERESTING CASE PRESENTATION : 

INTERESTING CASE PRESENTATION Dr. Sandhya Kamath Unit

Case history : 

Case history Snehal 27 yrs female, R/O Diva, married, housewife Patient was asymptomatic 6 mths back Patient p/w/c/o - tingling and numbness:- episodic - starting in Left LL toes - gradually progressing proximally involving whole LL - spreading upwards involving Lt UL - lasted for 4 hrs, spontaneously recovered - F/b heaviness of Lt UL & LL, lasting for whole day - 4 episodes in last 6 mths, including once in sleep ? when pt woke in night with same heaviness of limbs

Negative history : 

Negative history No h/o fever No h/o Vx, LM No h/o trauma, pain in neck No h/o loss of conciousness, convulsions Patient not a known case of HTN, DM, PTB

On Examination : 

On Examination GC- fair P- 76/min regular BP- 110/70 mm of Hg No POLICE CVS - heart sounds heard normally P/A - soft RS - AEBE CNS- pt concious oriented No focal deficit No neck stiffness

Investigations : 

Investigations Hb- 9.3 WBC- 6800 DLC- 72/26/2/0 PLT- 214000 LFT/RFT- WNL RBS- 89 Na/K- 138/3.4 Ca- 8.2 Mg- 2.0 Free T3/T4/TSH- 3.09/0.97/2.37

Inv. contd : 

Inv. contd MRI brain with epilepsy protocol with screening of cervical spine Normal study EEG- Baseline beta activity in range 10-13 cps E/o occassional bursts of sharp wave discharges No e/o slow waves Imp- EEG s/o seizure activity

Our impression : 

Our impression Somatosensory seizure disorder

Treatment : 

Treatment Tab eptoin (100mg) tds Tab Cal Lactate (500mg) tds Tab Folic Acid (5mg) tds

Somatosensory seizures : 

Somatosensory seizures Subtype of simple partial seizures Focus of seizures- C/L postrolandic convolution Sensory disorder- Numbness, tingling, “pins & needles” feeling Occasionally sensation of formication, electricity, movement of body parts Rarely pain & thermal sensations

Somatosensory seizures : 

Somatosensory seizures Etiology- in ~70% cases etiology can be ascertained ICSOL, AV malformations, intra cranial hemorrhages responsible for majority cases In 30% etiology not known

Somatosensory seizures : 

Somatosensory seizures Onset of seizures- in majority cases lips, fingers, or toes Spread to other parts follows a pattern determined by sensory arrangements in postrolandic convolution of the parietal lobe

Investigations : 

Investigations Imaging studies CT/MRI scan SPECT PET scan Functional MRI scan Electroencephalogram

Treatment : 

Treatment Antiepilaptics Neurosurgery

Slide 14: 

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