| Course | PA 528 Comprehensive Clinical Module Neurology |
|---|---|
| Week | 5 |
| Paper type | Seizure semiology write-up |
| Length | About 710 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | Master of Physician Assistant Studies (MPAS) |
| Updated | October 2026 |
Free sample paper for PA 528 Week 5
Seizure Semiology Write-Up: A Tingling That Climbed B.T.'s Left Hand, Jerking That Marched to the Face, Lost Awareness, a Bilateral Convulsion and a Weaker Left Arm for Forty Minutes Afterward
Student Name
Chamberlain University
PA 528: Comprehensive Clinical Module Neurology
Instructor Name
Month Day, Year
Seizure Semiology Write-Up: A Tingling That Climbed B.T.'s Left Hand, Jerking That Marched to the Face, Lost Awareness, a Bilateral Convulsion and a Weaker Left Arm for Forty Minutes Afterward
Stage 1: Before Anyone Noticed (Subjective)
Nine weeks after the stroke, B.T. was sitting at the kitchen table. In B.T.'s own words, later that day: "My left fingers started buzzing, like when your foot falls asleep, and it went up into my wrist. I knew something was wrong. I tried to call out." B.T. does not remember anything after that. This stage is reported by the patient and cannot be observed; it is recorded as subjective.
Stage 2: The Earliest Observed Feature
B.T.'s spouse, across the table, saw the left hand begin to jerk rhythmically, about two jerks a second, while B.T. looked at it and tried to speak. That is the first thing a witness saw, and it does most of the localizing: rhythmic jerking of one hand, preceded by tingling in the same hand, points to the area of the right cortex around the central sulcus where the hand is represented for both movement and sensation.
Stage 3: The Evolution, Described as Movements
Over about 20 seconds, the jerking spread from the hand to the forearm, then to the upper arm and then to the left side of the face, which twitched at the corner of the mouth. The spouse described it as "creeping up the arm into the face." Then B.T. stopped responding to their name, the head and eyes turned to the left, and about 30 seconds later both arms and legs stiffened and then jerked together for roughly a minute. B.T. bit the right side of the tongue and was incontinent of urine.
Classification
In the terms of the International League Against Epilepsy classification, this was a focal onset seizure, beginning with sensory and then clonic motor features, with impaired awareness, evolving to a bilateral tonic-clonic seizure (Fisher et al., 2017). The march from hand to face follows the order in which the body is represented along the motor strip.
Afterward Counts
B.T. was confused for about 20 minutes and recognized the spouse after 15. The left arm was much weaker than it had been since the stroke, unable to lift against gravity, and returned to its usual strength over about 40 minutes. A temporary worsening of weakness on the side of the seizure, a postictal paresis, supports a focal onset on the opposite side of the brain. The right-sided tongue bite fits a convulsion, not a faint.
Reading the Stages Backward
Working backward from the end: the postictal left arm weakness points to the right hemisphere. The bilateral convulsion shows spread to both sides. The turn of head and eyes to the left points to the right frontal lobe being involved as the seizure spread. The march from hand to face points to the right motor strip. The first feature, tingling in the left fingers, points to the right sensory strip just behind it. All stages point to the right perirolandic cortex, at the edge of the area injured by the stroke.
Why This Matters
A seizure arising from the edge of an old stroke, weeks or more after it, is a late post-stroke seizure, which carries a high risk of recurrence. The American Academy of Neurology guideline on a first unprovoked seizure notes that a prior brain injury such as a stroke raises the risk of another seizure, and that this risk informs the decision to start medicine (Krumholz et al., 2015). B.T. drives occasionally; a state driving restriction applies and was discussed.
What the Witness Account Could Not Supply
The spouse could not say exactly when awareness was lost, because B.T. kept looking at the hand for a few seconds. Nobody timed the convulsion. These gaps are recorded rather than filled in, and a smartphone video of any future event was suggested, since video helps the neurologist far more than a description.
References
Fisher, R. S., Cross, J. H., French, J. A., Higurashi, N., Hirsch, E., Jansen, F. E., Lagae, L., Moshe, S. L., Peltola, J., Roulet Perez, E., Scheffer, I. E., & Zuberi, S. M. (2017). Operational classification of seizure types by the International League Against Epilepsy: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia, 58(4), 522-530. https://doi.org/10.1111/epi.13670
Krumholz, A., Wiebe, S., Gronseth, G. S., Gloss, D. S., Sanchez, A. M., Kabir, A. A., Liferidge, A. T., Martello, J. P., Kanner, A. M., Shinnar, S., Hopp, J. L., & French, J. A. (2015). Evidence-based guideline: Management of an unprovoked first seizure in adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology, 84(16), 1705-1713. https://doi.org/10.1212/WNL.0000000000001487
The Chamberlain PA 528 Week 5 instructions
Week five calls for a seizure write-up organized in stages rather than impressions. Start with what happened before anyone noticed, in the patient's own words where possible, and mark it as subjective. Give the earliest observed feature its own section, since it does most of the localizing. Then describe the evolution as movements and behaviors, using a witness's words where helpful, without jumping to labels. Record what happened afterward, including confusion, weakness and injuries, because recovery is evidence too. Classify the event using the current international scheme, starting from its onset rather than its most dramatic phase. Read the stages backward to locate the onset. Note any gaps in the account. Close with why the localization matters for the patient and cite your sources.
How this PA 528 Week 5 example is built
The write-up begins with B.T.'s description of buzzing that rose from the left fingers into the wrist, marked as subjective. The spouse's first observation, rhythmic jerking of the left hand while B.T. looked at it, gets its own section and is linked to the right hand area around the central sulcus. The evolution describes jerking spreading up the arm to the face, loss of response, head and eyes turning left and a minute of bilateral stiffening and jerking with a tongue bite. The ILAE 2017 classification is applied. The aftermath records confusion and 40 minutes of worse left arm weakness. Reading backward places onset in the right perirolandic cortex at the edge of the stroke. Further sections note the witness gaps, suggest video and cite the AAN guideline on recurrence risk after brain injury.
Reading the PA 528 Week 5 grading rubric
The weight in this rubric sits on staging and description. A write-up that opens with a diagnosis such as tonic-clonic seizure, or that uses labels in place of described movements, loses the most because the localizing information disappears. Faculty next look for the earliest reliable feature in its own section and for the patient's account clearly marked as subjective. Credit goes to the aftermath, since postictal findings carry localizing value. Classification must start from the onset, using current terms; classifying by the convulsion alone is marked down. Reading the stages backward to a single region earns a substantial share. Acknowledging gaps in the witness account adds credit. Current classification and guideline sources should be cited.
Common PA 528 Week 5 mistakes, and how to avoid them
Students often lose marks on this assignment by naming the seizure type first and describing it afterward. With the patient and witness accounts in hand, a custom write-up would lay out the stages in order, mark the subjective part, give the first observed feature its own section and describe each movement without labels. The aftermath is recorded as evidence, and the event is classified from its onset using the current scheme. The stages are then read backward to a likely region, and any gaps in the account are named. If your case is a generalized-onset or nonmotor seizure, the structure still applies with different features. The witness details you submit must be the ones recorded in your case.
Get a PA-528 Week 5 example written to your instructions
Send the assignment wording, the witness account as your classroom supplies it, and any stage headings the template uses. A custom seizure semiology write-up built on that account comes back inside 24-48h and the first is free. Where the task asks for two sources on semiology, say so and they are included in the style your section requires.
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PA 528 Week 5 questions, answered
The account I was given is second hand and vague. Does that ruin it?
No, and vagueness is often built into the task. The example records exactly how the information arrived, marks which stages rest on report rather than observation, and argues only as far as that allows. A write-up that states its own limits scores better than one that fills the gaps with confident detail nobody witnessed.
Should the write-up name a seizure type?
Where the task asks for one, yes, and it belongs at the end after the stages have been laid out. Classification is a conclusion drawn from semiology, so an example that leads with the label has thrown away its own evidence. The safer arrangement, and the one most rubrics reward, puts the observed features first and the terminology last.
How are times handled when nobody looked at a clock?
They are written as ranges with the source attached, which is what a grader expects rather than invented precision. An example might record an interval as reported by a family member at somewhere under two minutes and then note that the estimate is the softest part of the timeline. Naming the uncertainty is treated as accuracy here, not as hedging.
Where can I find a free PA 528 Week 5 sample paper?
This page holds the full PA 528 Week 5 semiology write-up, a focal seizure from the left hand that marched to the face and became a bilateral convulsion.
How does the PA 528 Week 5 sample classify the event?
As a focal onset seizure with sensory then clonic features and impaired awareness, evolving to bilateral tonic-clonic, using the 2017 ILAE scheme.