Abstract

GOMES, Marisa Monteiro  and  REBELO, Susana Patrícia Leal. Concerning an inaugural convulsive crisis: a case report. Rev Port Med Geral Fam [online]. 2019, vol.35, n.4, pp.318-322. ISSN 2182-5173.  https://doi.org/10.32385/rpmgf.v35i4.12051.

Introduction: The inaugural convulsive crisis is a frequent cause of recurrence to the emergency department. It is estimated that only 40 to 50% of these cases have recurrent episodes. Thus, in the face of an inaugural convulsive crisis, it is important to exclude some conditions that may mimic the onset of convulsions. Case description: Female, 45 years old, married, diagnosed with uterine myoma, fibrocystic breast disease, anxiety disorder and medication abuse (alprazolam). In September 2016, she went to the emergency department due to an inaugural tonic-clonic convulsive crisis, with no apparent triggering factors. After exclusion of infectious, vascular and space occupant lesions of the central nervous system, she was discharged with the diagnosis of an epileptic seizure with unknown etiology, medicated with levetiracetam. In January 2017, she applied to the family physician to show the discharge note when questioned she admitted the abrupt withdrawal of alprazolam a few days before the seizure, despite indications of gradual reduction of the drug. In March she was hospitalized for delirious ideas and incoherent speech after acute gastroenteritis. She was discharged with the diagnosis of an acute confusional episode of organic/iatrogenic etiology. After the discharge, she went to the family physician and admitted to continuing abusing alprazolam, which she suddenly stopped when she had the gastroenteritis. The patient did not recognize the abusive use of the drug. The family, although initially having difficulties in dealing with the situation, ended up being an important ally in the treatment of this patient. Comment: This clinical case illustrates several complex situations in clinical practice, namely the difficulty in understanding the patient as a whole in the context of urgency, the absence of an effective communication system between the different levels of care, the omission of information by patients and the abuse of certain drugs. It highlights the importance of the family involvement in the treatment and follow-up of different clinical situations, as well as the role of the family physician, who through the longitudinal follow-up of the patient and a better doctor-patient relationship better knows him.

Keywords : Benzodiazepines; Abstinence syndrome; Seizure; Family physician.

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