46/ MALE/ INDIAN U/L 1) HYPERTENSION X20 YEARS -FOLLOW UP ION KK RANTAN 2) GOUT -FOLLOW UP IN KK RANTAN 3) H/O CVA X6 YEARS -FOLLOW UP IN KK RANTAU

4) POST CVA EPILEPSY SINCE 6 YEARS AGO 5) H/O ADMISSION 3/11/11-7/3/11 D/T EPIDI P/W 1) TONIC MOVEMENT OF UPPER LIMB AND LOWER LIMB IN THE MORNING OF ADMISSION (+) UPROLLING OF EYEBALLS (+) DROOLING OF SALIVA (+) LOC (UNSURE OF DURATION) (+) POST ICTAL DROWSINESS (+) BP/PU INCONTINENCE 2) FEVER X1/7 3) DIARRHEA X1/7 -2 EPISODES -LOOSE STOOLS BROWN COLOUR -PATIENT WAS BROUGHT BY CHILDREN TO THE HOSPITAL -BROTHER HAD EPILEPSY(DIED) -PATIENT HAS BEEN TAKING T. EPILEM OD ALL THIS WHILE DESPITE KK PRESCRIBING 400 MG BD. PATIENT DID NOT TAKE MEDICATIONS X1/12 O/E ALERT, CONSCIOUS BP 123/84 RR 20 T 37,9 SPO2 99% UNDER NP 3L/MIN REFLO 10.2 CVS S1S2 LUNGS CLEAR EQUAL A/E P/A SNT NO PEDAL EDEMA PROGRESS IN WARD: PATIENT FITTED AT 5.20PM ON 8/11/13. TONIC MOVEMENT WITH UPROLLING OF EYES, DROO LING OF SALIVA AND BITING OF TONGUE. FITTED ABORTED AFTER IV VALIUM 5MG STAT GIV EN. NOTED FOR 30 SECONDS.SUBSEQUENTLY, PATIENT DID NOT HAVE ANY MORE FITS. UPON DISCHARGE, -NO MORE FIT -AMBULTING WELL -TOLERATING ORALLY -AFEBRILE O/E ALERT, CONSCIOUS BP 119/76 RR 20 T 37 SPO2 99% UNDER RA

PERINDOPRIL 4MG OD -T. EPILEM 200MG BD -T. THIAMINE 100MG X1/12 -ORAL PASTE 1/1 DIAGNOSIS: BREAKTHROUGH SEIZURE SECONDARY TO NON-COMPLAINCE TO MEDICATION .CVS S1S2 LUNGS CLEAR EQUAL A/E P/A SNT NO PEDAL EDEMA INVESTIGATIONS: CT BRAIN: LEFT EXTERNAL CAPSULE LACUNAR INFARCT -MEMO TO KK TO REPEAT RP X2/52 -T. ASPIRIN 75MG OD -T.

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