C09979772 / invoice 10000

seizure this afternoon? has stopped as of 1:15pm sm
has video of episode. has seen SASH for this issue in january. is prepared to be referred again if necessary. 
will come straight down if his condition changes. sm

Verified: NO

HISTORY
Presenting for: Panda presented for a second episode of abnormal movements/possible seizure activity that occurred this morning while lying on a chair in the kitchen.

Historical Conditions:
- Previous episode 27/12/24 with left rear leg becoming stiff and rigid, progressing to whole body shaking while lying on his side, followed by exhaustion
- SASH neurology consultation 20/01/25 - movement disorder suspected (inflammatory, immune-mediated or infectious causes considered), more consistent with movement disorder than generalised seizure, possible partial seizure not completely ruled out, forebrain localisation suggested
- Blood tests in December were unremarkable
- Chronic paw licking issue with poor response to treatments
- Arthritis in hind legs
- Anal gland issues

Diet:
- Recent increase in appetite, described as fake hunger - has since settled

Current Meds:
- Cytopoint injection trialled previously but owners felt it didn't suit him
- Not currently compliant with paw treatments

Lifestyle Risk Factors:
- Works from home environment, usually indoors

Other:
- First episode occurred during Christmas stress with family and children around, initially attributed to stress
- For the past 12 months, intermittent trembling of individual legs when standing, moving between different legs
- Today's episode occurred during relaxed state with no apparent triggers
- Video of today's episode sent to SASH for review

EXAM
Mentation: BAR
T: 38.3°C
Behavioural: Cooperative for examination, appeared happy and alert
Eyes: Pupils constricting evenly bilaterally, normal menace response bilaterally
Neurologic: Normal pupillary light reflexes, normal menace response, normal proprioceptive responses when feet turned upside down
Musculoskeletal: No spinal discomfort on palpation, normal range of motion in all joints, no pain on manipulation of legs that were affected during episode
Integumentary: Paw licking dermatitis noted

ASSESSMENT
Movement disorder - Second episode in 3 months, different presentation from first episode (right-sided involvement vs previous left-sided), consistent with previous neurology assessment of possible inflammatory/immune-mediated/infectious movement disorder rather than seizure activity

Chronic allergic dermatitis with paw licking - Ongoing issue with poor treatment compliance

PLAN
Additional Discussion:
- Video of today's episode sent to SASH neurology for review
- Two management approaches discussed: monitoring for frequency and severity of episodes vs pursuing further investigation with brain imaging
- Given only 2 episodes in 3 months with relatively mild presentation, monitoring approach considered reasonable
- Further investigation with neurology recheck and brain imaging available if episodes become more frequent, severe, or prolonged
- Diary keeping recommended to track episode dates, times, duration, and characteristics
- Brain scan would rule out structural causes but epilepsy may not show on imaging

Client Comms:
- Today's episode appears less severe than previous episode with quicker recovery and no post-episode exhaustion
- Normal neurological examination findings reassuring
- Monitor for changes in frequency, duration, or severity of episodes
- Return for reassessment if episodes become more frequent or severe
- Neurology recheck available if owners wish to pursue further investigation