67. What happens in a seizure (Fits) ? Whether injuries are possible during seizure? The episodic impairment of consciousness and muscular control may occur even in absence of a clinical seizure in a patient suffering from seizure disorder. In addition, muscular incoordination and side effects of anti-epileptic drugs may contribute to the risk of injuries in a patient with seizure disorder. Some studies have shown that patients with seizure disorder are more frequently admitted to the hospital following an injury. The patients with seizure disorder are more likely to die as a result of an accident than non-epileptic patients. The most common injuries in these patients remain trivial injuries like contusions, wounds, abrasions and head concussions. 68. Whether not screening for epilepsy and not providing treatment of epilepsy & non-referral to specialist in a case of prisoner who upon entry in jail gives history of its (but not documented) subsequently dies due to heart attack or epileptic it; may amount to provision of inadequate patient care? If only history of epilepsy was available at the time of health screening upon entry in the prison, the provision of antiepileptic treatment is not mandatory in such cases. As per the guidelines of Indian epilepsy society 1. Antiepileptic drug (AED) therapy should be started only after the diagnosis of epilepsy is con irmed. 2. Treatment should be initiated following the occurrence of two or more unprovoked seizures, after discussing the risks and bene its of treatment with the person/family members. 3. If seizures continue despite trial with two AEDs, patient should be referred to a specialist for evaluation. 69. What are the characteristic features of alcohol withdrawal? When does alcohal withdrawal develops after its cessation? Alcohol withdrawal is characterized by tremors of the outstretched hands, tongue or eyelids, sweating, nausea, retching or vomiting, tachycardia or hypertension, excessive purposeless physical activities, headache, insomnia, malaise or weakness, transient visual/ tactile or auditory hallucinations or illusions, and generalized seizures. These features develop on recent cessation or reduction of alcohol after MEDICAL DIMENSION OF FREQUENTLY ENCOUNTERED CASES | 52