A seizure is a sudden, uncontrolled burst of electrical activity in the brain. It can cause changes in behavior, movements, feelings and levels of consciousness. Having two or more seizures at least 24 hours apart that don't have a known cause is considered to be epilepsy. There are many types of seizures, and they have a range of symptoms and severity. Seizure types vary by where they begin in the brain and how far they spread. Most seizures last from 30 seconds to two minutes. A seizure that lasts longer than five minutes is a medical emergency.

1. PRESENTED BY: SAMIRA BIGDELITABAR
PHARM D 5TH YEAR
A case presentation on Seizuredisorder -
GTCS.

2. CASE:
 A 40 year old female patient bearing an IP no
16/154 has been admitted in hospital on
01/01/2016 with complaints of GTCS with foam
coming out of the mouth and was discharged on
04/01/2016 after treatment.

3. PATIENT PROFILE:
 Patient name: XXX
 DOA: 01/01/2016
 DOD: 04/01/2016
 Age: 48 years
 Gender: female
 Dept. : Neurology.

4. SUBJECTIVE EVIDENCE
 Patient developed one episode of GTCS for around
one minute yesterday.
 Case of Unconsciousness, fainting and falling
down.
 Weakness of one side of the body ie. left side since
7 days.
PAST MEDICAL HISTORY:
K/C/O Depressive Illness.
PAST MEDICATION HISTORY:
Amitryptilline.

5. OBJECTIVE EVIDENCE
 Tempt: 98F
 RR: 104 bpm
 BP: 135/81 mmhg
 SPO2: 97%
 CNS: NAD
 Pulse: 82bpm
 EEG: Abnormal impulses.
 Prolactin: increased levels (69ng/ml).
Normal: 10-23ng/ml

6. DIAGNOSIS
 SEIZURE DISORDER(GTCS).

7. ASSESMENT
 From the above Subjective and Objective evidence
patient was diagnosed to be suffering from Seizure
disorder.

8. GOALS OF THERAPY
 Patient specific:
To calm down the patient and to relieve the symptom.
 Disease specific:
To prevent further complications, to treat seizure
disorder and to control it.

9. TREATMENT CHART
Trade name Generic name Dose Rou
te
Freque
ncy
Day
1 2 3 4
Inj. Pan. Inj
Pantoprazole
40
mg
Iv 1-1-1 + - +
+
Inj. Eptoin Inj Phenytoin 100
mg
Iv 1-1-1 + + +
+
Tab. Nexito
plus
Tab
Clonazepam
0.5
mg
Po 1-1-1 - + + -
Inj. Diclo Inj Diclofenac 1
amp
Iv stat + - + -

10. ASSESMENT OF THERAPY
1. Pantoprazole:
It is a Proton Pump Inhibitor.
It blocks proton pump reducing gastric acidity.
Justification: To prevent drug induced peptic
ulcer.

11.  Phenytoin:
It is an anti-epileptic drug.
It works by increasing the Na efflux or decreasing Na
influx from membrane in motor cortex neurons thus
stabilizing neuronal membrane.
Justification: it is given to control seizure.

12.  Clonazepam:
It is an anti-anxiety and anti-convulsant drug.
It is a long acting Benzodiazepine that increases the
GABA inhibition and reduces the monosynaptic and
polysynaptic reflexes.
Justification: it is given to treat the seizure disorder
and also to calm the patient as she is anxious.

13.  Diclofenac sodium:
It is NSAID
It works by inhibiting the Cyclo-oxygenase (COX) 1
and COX-2 thereby inhibiting prostaglandin synthesis.
Justification: It is given to relieve pain.

14. MONITORING PARAMETERS
 Pantoprazole: stomach pain, blurred vision, dry
mouth, nausea, dizziness.
 Phenytion: headache, fatigue, rash, diarrhea
 Clonazepam: body pain, fatigue, cough, dizziness.
 Diclofenac Na: diarrhea, dizziness , peptic ulcer ,
rash.

15. DRUG INTERACTION
 PHENYTOIN <------------> CLONAZEPAM
When used together, the blood level of Phenytion can
be altered by Clonazepam resulting in the altered
effects of phenytoin.
Causes loss of seizure control or symptoms that may
suggest excessive Phenytoin levels such as nausea,
vomiting, blurred vision etc.
INFERENCE:
Moderate interaction.

16. PHARMACIST INTERVENTION
 The interacting drugs frequency should be
changed.

17. PROGRESS CHART
 Day 1: Patient was un-stable, depressive, having
headache.
 Day 2: stable with vitals but complaints of
headache.
 Day 3: stable with vitals and reduced signs and
symptoms.
 Day 4: patient stable, discharged.

18. PATIENT COUNSELLING
 Avoid driving alone.
 Take medication on time.
 If missed dose consult the doctor for the further
planning.
 Sleep well
 Have a regular meals and balanced diet.
 Learning the relaxation technique
 Avoid of drinking alcohol
 During the bath turns the taps off before getting in.
 Avoid stress and emotional upset.

19. COUNSELLING TO REPRESENTATIVE
 Do not immobilize the patient from the place where
seizure attack occurred.
 Place the patient on the Recovery Position.
 If patient is secreting saliva, clean it wit a clean
clothes.
 Tilt the head of the patient backward to prevent
from blocking the airway.
 Place thick paper or leather wallet between the
jaws to prevent biting the tongue.
 No metallic objects should be given, patient may
harm oneself.

20. DISCHARGE MEDICATION
 Tab Eptoin 100 mg 1-0-1 X 3 months
 Tab Pan 40 mg 1-0-1 X 1 week
 Tab Nexito + 0.5 mg 0-0-1 X 1 month
REVIEW: After 3 months.

21. WITH REGARDS.
THANK YOU 