36Y OLD FEMALE PATIENT CAME WITH C/O INVOLUNTARY MOVEMENTS OF RIGHT UPPER LIMB SINCE 1HRPATIENT WAS APPARENTLY ASYMPTOMATIC 1 HR AGO,THEN SHE DEVELOPED INVOLUNTARY MOVEMENTS OF RIGHT UPPER LIMB,NOT ASSOCIATED WITH LOC, INCONTINENCE( fecal/urinary), VOMITING,PAIN ABDOMEN, FEVER,COUGH, COLD, DROOLING OF SALIVA,UPROLLING OF EYES,TONGUE BITE,POST ICTAL CONFUSION . PATIENT WAS C/C/C DURING SEIZURES.H/O SIMILAR COMPLAINTS YESTERDAY NIGHT WHICH WAS ASSOCIATED WITH ONE EPISODE OF VOMITING,LOC WHICH SUBSIDED AFTER INJ.LORAZEPAM 2 CC IV/STAT AND SENSORIUM IMPROVED AFTER SEIZURE ATTACK WITH NO POST ICTAL CONFUSION.FIRST SEIZURE ATTACK WAS 18 YEARS AGO WHICH WERE INVOLUNTARY MOVEMENTS OF RIGHT UPPER LIMB AND LEFT LOWER LIMB WHILE SHE WAS PREGNANT .THERE WERE EPISODES OF SIMILAR COMPLAINTS (6-8 TIMES - OUT OF WHICH 3-4 TIMES SHE HAD INVOLUNTARY MOVEMENTS OF RIGHT UL AND LL WHILE REMAINING TIMES SHE HAD ONLY RIGHT UL MOVEMENTS AND EVERYTIME SHE HAD H/O LOC AND IN 8 MONTHS AGO EPISODE SHE WAS C/C/C DURING SEIZURE EPISODE) .

36Y OLD FEMALE PATIENT CAME WITH C/O INVOLUNTARY MOVEMENTS OF  RIGHT UPPER LIMB SINCE 1HR
PATIENT WAS APPARENTLY ASYMPTOMATIC 1 HR AGO,THEN SHE DEVELOPED INVOLUNTARY MOVEMENTS OF RIGHT UPPER LIMB,NOT ASSOCIATED WITH LOC, INCONTINENCE( fecal/urinary), VOMITING,PAIN ABDOMEN, FEVER,COUGH, COLD, DROOLING OF SALIVA,UPROLLING OF EYES,TONGUE BITE,POST ICTAL CONFUSION . PATIENT WAS C/C/C DURING SEIZURES.
H/O SIMILAR COMPLAINTS YESTERDAY NIGHT WHICH WAS ASSOCIATED WITH ONE EPISODE OF VOMITING,LOC WHICH SUBSIDED AFTER INJ.LORAZEPAM 2 CC IV/STAT AND SENSORIUM IMPROVED AFTER SEIZURE ATTACK WITH NO POST ICTAL CONFUSION.
FIRST SEIZURE ATTACK WAS 18 YEARS AGO WHICH WERE INVOLUNTARY MOVEMENTS OF RIGHT UPPER LIMB AND LEFT LOWER LIMB WHILE SHE WAS PREGNANT .
THERE WERE EPISODES OF SIMILAR COMPLAINTS (6-8 TIMES - OUT OF WHICH 3-4 TIMES SHE HAD INVOLUNTARY MOVEMENTS OF RIGHT UL AND LL WHILE REMAINING TIMES SHE HAD ONLY RIGHT UL MOVEMENTS AND  EVERYTIME  SHE HAD H/O LOC AND IN 8 MONTHS AGO  EPISODE SHE WAS C/C/C DURING SEIZURE EPISODE) 
PAST HISTORY:
K/C/O SEIZURE DISORDER SINCE 18 YEARS (ON IRREGULAR MEDICATION)
N/K/C/O HTN,DM,CVA,CAD, THYROID DISORDERS.
PERSONAL HISTORY:
DIET - MIXED
SLEEP - ADEQUATE
BOWEL AND BLADDER MOVEMENTS - REGULAR
NO H/O ALLERGIES
OCCASIONAL TODDY DRINKER
NO H/O TOBACCO INTAKE
NO H/O WEIGHT LOSS
FAMILY HISTORY:
N/K/C/O HTN,DM, EPILEPSY,ASTHMA,TB, THYROID DISORDERS.
GENERAL EXAMINATION:
PATIENT IS C/C/C WELL ORIENTED TO TIME,PLACE AND PERSON.
PALLOR+ 
NO ICTERUS, CYANOSIS, CLUBBING, LYMPHADENOPATHY,EDEMA.
VITALS:
TEMPERATURE: 98.2F
PR: 78 BPM
RR: 16 CPM
SPO2: 99%
GRBS:106 MG/DL
SYSTEMIC EXAMINATION:
CVS: S1,S2 +,NO MURMURS
RS: BAE+ , NVBS
P/A :
SOFT NON TENDER
CNS:
                         RT.          LT
POWER. UL.   5/5.       5/5
                 LL.    5/5.      5/5
TONE.    UL.       N/INCREASED.                    N
                LL.        N.          N
REFLEXES
          B.               +3.        +2
          T.                +3.      +2
           S                +2.     +2
           K.               + 2.     +2

TREATMENT:
1. INJ.LEVIPIL 1 GM IV / STAT
2. INJ.LORAZEPAM 2CC IV/ SOS ( IF SEIZURE ATTACK) 
3.MONITOR VITALS 4 TH HOURLY AND INFORM SOS

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