21st June 2023

A 15-year-old boy is brought into A&E following a generalised tonic-clonic seizure that lasted 2 minutes

A 15-year-old boy is brought into A&E following a generalised tonic-clonic seizure that lasted 2 minutes. This is his first seizure.

His mother, who was with him, reports he has been struggling in class in the last few months and it takes longer for him to do his homework. She has noticed a slight slurring of his speech, as if he has had alcohol. He has also been mildly drooling and is unable to control this. His hands have been shaky at rest for a while, and sometimes he has had painful contractions in his hands and arms, causing involuntary, repetitive movements. He has also been clumsier and finding it more difficult to pick things up and dress himself. His walking is unsteady as well.

What is the most likely underlying diagnosis to explain his presentation?