Learning points  - This is a case of 65 year old female with Generalised Tonic Clinic seizures  Osce questions 1) Reasons for seizures in old age people  * Neurodegenerative disorders * Cerebrovascular disorders  * Dementia  * Metabolic disorders      - Hypoglycemia      - electrolyte imbalances     - uraemia * Physical or mental exhaustion  2) pathophysiology of seizures  * To function normally brain must maintain a continual balance between excitation and inhibition , remaining responsive to environment while avoiding continued unrestrained  spontaneous activity * GABA inhibitory neurotransmitter acts on ion channels , enhances inflow of chloride and reduces formation of action potential  * Excitatory amino acids allow  influx of sodium and calcium and producing opposite effects  * It is likely that many seizures results from an imbalance between this excitation and inhibition.  ( From ...