Clinical Case Presentation on Absence Seizures Diagnosis and Treatment Care Services and Outcomes in an Adult Patient

INTRODUCTION

Seizure is a short episode of abnormal electrical activity in the brain with intense electrical signals.[1] Typically, absence seizure lasts from few seconds to minutes with the loss of consciousness and no any marked convulsions, often occur in children aged <10 years.[12] Absence seizures explicit behavioral arrest, unresponsiveness, cyclic blinking of eyelids, suddenly stopped speech and movement, mouth chewing, lip smacking, and rubbing fingers. The diagnosis includes complete blood count test, brain computerized tomography scan, magnetic resonance imaging (MRI), electroencephalogram, and cerebrospinal fluid examination which provides the evidence and demonstrates clearly the origin of seizure lesions in the brain. The prevention and management of the absence seizure can be done using phenytoin and carbamazepine with the ketogenic diet.[3456]

CASE REPORT

Mr. VA, a 25 year old male patient with an episode of absence seizures, was presented to the general medicine with loss of consciousness lasted for 2–4 min, giddiness, and dimness of vision. The patient reported that he regained from his loss of consciousness after few minutes, however, the giddiness persisted. The patient had no vomiting, involuntary movements, headache, fever, urinary incontinence, and palpitations.

Neurological investigation reports

The patient's central nervous system examination revealed normal higher functions with no motor sensory deficits and bilateral plantar flexor. The electroencephalogram of the brain showed that the electrical waves remained normal with some electrode artifacts confirming the detection of absence seizure [Figure 1].

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Figure 1

Electroencephalogram of the brain

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The patient's brain MRI scan revealed the presence of small focal flair hypertensive area in the right parasellar region close to cavernous sinus and mild flair hypersensitivity in the left cavernous sinus. The MRI scans also revealed right maxillary and ethmoid sinusitis and no blooming restrictions were noted[7] [Figure 2 and Table 1]. Patient medications chart.

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Figure 2

Magnetic resonance image scan of the brain

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Table 1 Patient medications chart

DISCUSSION

The above clinical findings and laboratory tests reported that the patient was detected with the episodes of absence seizures. In the case, the patient was presented with absence seizures which progressively associate with temporary loss of consciousness.[8] The etiology represented that there was an increase in the cerebral blood flow, increased intracranial pressure which ultimately provokes the development of seizure; it was evident in the case of Mr. VA. The patient's pathophysiology revealed neuronal changes which led to changes in the reticulothalamocortical circuitry which may be associated with genetic liability exhibiting absence seizure.[9] Patient has not incurred any kind of symptoms in his childhood, however it was manifested recently. A study by Avanzini et al., showed an increased oscillatory activity in the reticulothalamocortical circuitry proved to be the cause for the absence seizure which has made a promising diagnostic tool in this patient.[910]

Since the patient's mother had seizure and had not underwent any proper treatment which may be due to the economic status which may be the reason conjoined with genetic liability in this case.[11]

As reported by Thomas et al. sudden withdrawal of drugs, such as diazepines, psychotropic, antidepressant drugs, autoimmune diseases, brain accidents, and electrolyte disturbances being a factor which imposes the incidences of absence seizures.[56789101112]

After 1 week of hospital stay, the patient was treated with the drugs as shown in Table 1. He was thoroughly monitored and found that his vital signs were normal. He responded well to the medications, and diet intake was normal. He showed positive improvement in his conditions and showed no further seizure incidences. The patient was advised for stress management, adequate rest, and regular sleeping with healthy diet. The patient was asked for a follow-up every 3 months, and he was then discharged from the hospital.[21314] On his first follow-up visit, he was quite normal and taken the discharge medications regularly, and he reported no any new episode of seizures. An effective preventive measure toward the patient's health status can prevent the risk factors which ultimately improves better quality of life, as reported by Nutthaya Vongkasamchai et al.[15]

CONCLUSION

The pathophysiological mechanisms underlying epilepsy are autism spectrum disorder (ASD) resistance and sudden ASD dose reduction can trigger withdrawal response of seizure; hence, dose reduction or removal should be done gradually. Effective understanding of pathophysiological mechanisms, drug targeting, antiepileptogenesis, and genetics can provide a better understanding of epilepsy and its management. New molecular drug target, pharmacogenomics, and documentation of the individual patient's report can improve the treatments effectively.[1617]

Clinical pharmacist should be positioned in the clinical practice to identify the risk factors for seizure origin, early diagnosis, and treatment can reduce the healthcare cost. Initiating awareness programs on disease prevention and management, regular patient follow-up care, and medication adherence can reduce the individual's disease burden and hospital revisit which can ultimately promote health-related quality of life. Regular implementation of these practices among healthcare team can reduce the individual's healthcare cost and hospital revisit.