Recurrent seizures for the past 6 months

A, a previously healthy 7-year-old girl, was brought to the clinic by her mother due to recurrent episodes of seizures over the past six months. The seizures are described as sudden, lasting about 1–2 minutes, during which Amina becomes unresponsive, her eyes roll back, and she has generalized jerking movements of her arms and legs. Postictal, she is confused and drowsy for up to 30 minutes.

Her mother notes that the seizures have been increasing in frequency, occurring around 2–3 times per week. They are not associated with any known triggers such as fever or trauma. No history of head injury or recent illness was reported. The family lives in a rural area with limited access to healthcare and transportation, making it difficult for them to seek care earlier.

A's development was normal until about a year ago when her mother noticed some academic decline and increased difficulty concentrating in school. She has also had a few episodes of urinary incontinence during the seizures. There is no family history of epilepsy, but one of A’s younger siblings died at an early age from an unknown cause.

Vital Signs:

Temperature: 36.8°C

Heart rate: 92 beats per minute

Respiratory rate: 20 breaths per minute

Blood pressure: 105/65 mmHg

General: Alert and oriented between episodes, no obvious neurological deficits.

Neurological exam: Normal tone, power, and reflexes. No focal neurological deficits, but some difficulty with attention and concentration noted.

Head and neck: No signs of trauma or infection. Cranial nerves intact.

Developmental assessment: Mild regression in academic skills, no motor or speech delays.

Electroencephalogram (EEG): Shows generalized spike-and-wave discharges, confirming a diagnosis of generalized epilepsy.

Brain MRI: Normal, no structural abnormalities.

Blood tests: Normal glucose, electrolytes, and no evidence of infection.

A is diagnosed with generalized epilepsy based on her clinical history of recurrent unprovoked seizures and the characteristic EEG findings. The cause of her epilepsy is likely idiopathic, given the absence of any structural abnormalities or metabolic issues.

1. Antiepileptic medication:

Initiate treatment with sodium valproate, with regular follow-up to monitor response and side effects.

Provide education to A’s family on the importance of medication adherence, especially in rural settings where access to healthcare is limited.

2. Seizure safety education:

Educate the family on seizure first aid, including protecting A during seizures and preventing injury.

Discuss avoiding swimming alone and supervision during activities to prevent accidents during seizures.

3. Psychosocial support:

Address the academic decline by referring A to a local school with teachers who are aware of her condition and can provide additional support.

Provide the family with information about epilepsy support groups in the region to reduce stigma and improve community understanding.

4. Follow-up:

Regular monitoring of seizure frequency and adjustment of medication as necessary.

Follow-up every 3 months at the nearest health facility to assess her development and seizure control.

A’s seizures gradually became less frequent after starting medication, with better control after three months of treatment. However, challenges remain due to the family’s limited access to healthcare and medication in their rural area. The clinic arranged for a community health worker to visit regularly to ensure medication adherence and follow-up. With continued support and education, A’s condition is expected to improve, allowing her to return to school with fewer interruptions.