Here's a brief look at the case presentation of GTCS.

1. GENERALIZED TONIC-CLONIC SEIZURE
Hashim Syed Ali Abbas H
170312882029
PharmD VIth year
INTERNSHIP
MESCO college of pharmacy

2. GENERALIZED TONIC-CLONIC
SEIZURE
Tonic-Clonic Seizures
Tonic–clonic seizures are a type of generalized
seizure that affects the entire brain.
The seizures are divided into two phases:
Tonic phase
The person will quickly lose consciousness, and is
characterized by stiffening of the muscles.
Clonic phase
The person's muscles will start to contract and
relax rapidly, causing convulsions this phase is
characterized by repetitive, rhythmic jerks that
involve both sides of the body at the same time.

4. Clinical features
Many patients with generalized tonic-clonic seizures have
vision, taste, smell, or sensory changes, hallucinations,
or dizziness before the seizure. This is called an aura.
The seizures usually involve rigid muscles, followed by
violent muscle contractions, and loss of alertness
(consciousness).Other symptoms that may include:
• Biting the cheek or tongue
• Loss of urine or stool control (incontinence)
• Stopped breathing or difficulty breathing
• Blue skin color
After the seizure, the person may have:
• Sleepiness Loss of memory (amnesia) regarding events
surrounding the seizure episode
• Headache
• Drowsiness
• Confusion
• Weakness of one side of the body for a few min- to hours
following seizure (called Todd paralysis)

5. SUBJECTIVE
Patient’s Name: T. Swamy
Gender: Male
Age: 29years
I.P no: 12791
Occupation: Employee

6. Complaints
Patient had a GTCS for 30 minutes,followed by total
confusion for 10 minutes.
H/o Tongue bite
Sleep distubance(Nocturnal paroxysmal events eg:sleep
apnea)
Past History
H/o similar seizures in 2004 and 2012 not on Rx
Addictions
Smoking:Occasionally
Alcoholic:2-3 units/week

7. OBJECTIVE
Vital Data
Lab Investigations
→Biochemical Investigations:Normal
→Urine Analysis:Normal
Day 1 2 3 4
Pulse Rate 80/min 82/min 84/min 82/min
B.P 120/80mmHg 130/90mmHg 130/80mmHg 120/80mmHg
Resp. Rate 28/min 22/min 24/min 24/min
Temperature 98.6 °F 99°F 99°F 98.6°F

8. ASSESSMENT
RFT,LFT,FLP,Serum Electrolytes-Normal
Hemogram-Normal
Colour Doppler Echocardiograph-Normal
ECG-Atrial fibrillation is noted
CT-Scan- Swelling In Left parietal region of
brain(6cm*5cm)
Diagnosis
K/C/O Generalized Tonic-Clonic Seizures

9. Planning
Goals Of Therapy
1.The goal of treatment in patients with seizures is to achieve a
seizure-free status without adverse effects.
2.Prevent relapse or re-occuring of seizures.
3.Avoid or reduce undesirable side-effects that might result from the
medication.
4.Begin or return to normal, everyday activities such as work,
education, independent living, social relationships.

10. Treatment Options
1.Anti-convulsants:The following five drugs are known to be most effective in
the treatment of GTCs: valproate, lamotrigine, topiramate, levetiracetam and
zonisamide.
→ First-line treatment:sodium valproate.
2. Adjunctive treatment: lamotrigine as adjunctive treatment if first-line
treatment with sodium valproate is ineffective or not tolerated.
3.surgery
→focal resection
→hemispherectomy
→corpus colostomy surgery
4. Dietary Therapy
→Ketogenic Diet(consists of consuming high-fat foods and very few
carbohydrates)
5.Other somatic therapies
→Vagus nerve stimulation
→ Psychological interventions (relaxation, cognitive behaviour therapy)

11. Plan Of Treatment
Patient is to be treated with,
→Anti-Convulsants:for the prevention from the relaspe or re-
occurance of seizures.
→PPI’s:to relieve gastric discomfort (adverse effect)
→Mild Analgesics/Antipyretics:for the fever.
→Muscle relaxants/spasmolytics:centrally acting muscle relaxants to
treat muscle spasms.

12. Day-1
→Received tab. Eptoin100mg (Phenytoin)on admission.
FORMLn
Drugs Generic Classification Dose Frequen
cy
Rout
e
Injection Lavera Levetiracetum Anti-convulsant 1000m
g
stat IV
Injection Lavera Levetiracetum Anti-convulsant 500mg BD IV
Injection PAN Pantoprazole PPI’s 40mg OD IV
Injection Lorazepa
m
lorazepam Benzodiazepin
es
4mg SOS IV

13. Day-2
→Dolo(antipyretic) was added to decrease fever.
→Lorazepam was discontinued,as the pateint sleeps well,without any
disturbances.
FORMLn Drugs
Generic Classification Dose Route Frequency
Injection Lavera Levetiracetum Anti-convulsant 500m
g
IV BD
Injection PAN Pantoprazole PPI’s 40mg IV OD
Tablet
Tablet
Dolo
Eptoin
Acetaminophe
n
Phenytoin
Mild Analgesic
Anti Epileptic
650m
g
100
Mg
OR
P/o
SOS
BD

14. Day-3
No Addition of drugs,patient’s condition stable was still in observation
Day-4.
Day-3 drugs+Addition of drugs,
→Powergesic-MR is added to decrease the muscle tone.
FORML
n
Drugs Generic
Classification Dose
Rout
e
Frequenc
y
Tablet Powergesic-
MR
Chlorzoxazon
e (500mg)
Diclofenac
(50mg)
Norfloxacin
(500mg)
Muscle
relaxant
1tab OR BD

15. Day-5
No Addition of drugs,Pateint’s condition was stable and was
discharged.
Drug Interactions
(Significant)
Lorazepam+Chlorzoxazone
-both increases sedation.
Discharge Summary
1. Tab. PAN(Pantoprazole) 40mg OD before breakfast.
2. Tab. Levera(levetiracetum) 500mg OD.
3. Tab. Powergesic-MR(Chlorzoxazone ,Diclofenac ,Norfloxacin) twice
daily for 5 days then SOS for pain.
4. Zytee gel(sodium flouride) for L/A.

16. Pharmacist recommendation
→Sodium valproate is the first line treatment for tonic-clonic seizures,
lamotrigine (if sodium valproate is not suitable).
→Alternative first line: treatment carbamazepine, oxcarbazepine.
→Patients should be well equipped with the knowledge of the
Treatment and its adverse effects.
→Dietary Therapy like Ketogenic Diet can be recommended to the
patient.
→Other somatic therapies like Vagus nerve stimulation can be done if
patient is not responding to medications.

17. Patient’s Counseling
→The patient should not be isolated at any point during his full course
of treatment.
→Educate family about the pateint’s condition and to Inspire them to
promote their full support.
→Promote medication adherence to prevent relapse or re-occurence of
seizures.
→Psychological interventions like cognitive behaviour therapy should
be recommended,as people with seizures experience psychosocial
adjustments after their diagnosis.