A 16 years old male presents with a first-time seizure event after attending an all-night party and consuming alcohol. Witnesses described the seizure as beginning abruptly with bilateral limb stiffening, followed by jerking movements in all limbs; the patient has no memory of warning symptoms prior to the seizure. The event seemed to last about 1 minute, and the patient was quite somnolent afterward. Further review of the history reveals that the patient has been experiencing “jerks” in the morning after awakening usually involving the arms and shoulders and occasionally causing him to drop things. These “jerks” do not seem to present a problem during the rest of the day. What are the most important differential diagnoses?

Of the relevant differential diagnoses, it is important to rule out brain tumor,movement disorders and substance induced or febrile seizures.

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This post was written by Omar Rifai