History of Present illness
According to the statement of informant mother , her child
was reasonably well two month back then she developed
seizure. The seizure was sudden, brief contraction of neck
and extremities. It occurred in cluster (3 – 4) episodes per
day and lasts for (3 - 5) minutes and during awakening.
There is no history of passing urine or defecation during
the episode of seizure.There was no postictical phemenon
.Mother also complainted that her child had no interest to
surroundings . There was no history of fever, vomitting,
respiratory problem, loss of consciousness or trauma.
For above mentioned complaints she visited general
pediatrician and was treated with anti epileptic drugs
for 4 weeks but the seizure didn’t improve .Then they
brought the child to BSMMU for better evaluation and
Antenatal : There was no history of fever, rashes,abortion
or sibs death.
Natal : Delivered by LUCS due to oligohydriamnios at
Postnatal: Baby cried immediately after birth.
Immunization as per EPI schedule started.
The child is on Exclusive breast feeding.
Milestones of Development
Gross motor :- no neck control
Fine motor :- palmar grasp present
Language :- cooing
Social :- smile present
No H/O consanguinity.
She is the only issue of her parents.
Other family member are healthy.
History of Past Illness
Phenobarbitone for 2 weeks.
Sodium Valproate for 2 weeks.
Belongs to poor socio-economical status
family , stays in pakka house , drink tubwell
DRUG REACTION HISTORY
No past drug reaction history present .
Lymph Node :- Not enlarged
Skin survey : – BCG mark present.
Signs of meningeal irritation : – Absent
Bony tenderness : – Absent
Fontanelle : - open but not bulged
Temperature – 98o F
HR – 120 beats /min
BP – 70/40 mm Hg
RR – 40 breaths /min
Weight - 5.5 kg, ( lies on 50th percentile)
Length - 62cm, ( lies on 25th percentile)
OFC - 38cm ( lies on 10th percentile )
• Patient is playfull
• Cranial nerve - Intact as per I exammined
• Motor :- Bulk of muscle – normal
Tone - normal
Jerk – Normal
• Sensory - normal
• Plantar – b/l extensor type
• Primitive reflex – normal
• Shape of the chest : normal
• R/R : 38 breaths/min
• Visible vein & Pulsation : absent
• Scar mark : absent
• Trachea : centrally placed
• Apex beat : left 5th ICS, medial to
• Resonant all over the lung fields
• Breath sound : vesicular
• Added sound : absent
No visible pulsation
• Apex beat : left 5th ICS,
• Thrill : absent
• P2 :Not palpable
• Lt. parasternal heave : absent
• 1st & 2nd heart sounds audible in all 4 areas
• Murmur : absent
Cardiovascular system examination
Mouth & Oral cavity:
Tongue : Normal
Gum : Normal
Buccal mucosa, tonsils & fauces : Normal
Alimentary system examination
Ahona 3 months old female child only issue of
non-consanguinous parent came from narayangonj,
was admitted with a complain of seizure for 2 month.
The seizure was sudden , brief contraction of neck
and extremities.It occurred in cluster (3 – 4) episodes
per day and lasts for 3 -5 min and during awakening.
There is no history of passing urine or defecation
during the episode of seizure . There was no post
ictical phemenon . Mother also complainted that her
child was not responsive to surrounding . She was
treated with anti-epileptic drugs for 4 weeks but the
condition didn’t improve. The child was delivered by
LUCS , there is no H/O perinatal Asphyxia.
On examination Ahona was alert ,playful , BP –
70/40 mm of hg , RR – 40/min , HR – 120 beats/min,
temperature – normal, BCG mark present, fontanels –
open but not bulged, signs of meningeal irritation -
absent ,lymph node – not enlarged , cranial nerve –
intact , bulk- normal , tone – normal , jerks – Normal,
plantar – b/l extension , lungs – B/L clear, P/A-Liver
just palpable . Other systemic exammination reveals
1) Early Myoclonic infantile encephalopathy
2) Early infantile epileptic syndrome
D/D Point in favor Point against
Seizure in cluster during
epilepsy in infancy
Age less than 2 month
Seizure in cluster
Early infantile epileptic
Age less than 2 month
Seizure in cluster