John is a 73-year-old male with a four-week history of lethargy and new partial seizures. He is a nursing home resident with dementia, requiring support for daily living activities.

Over the past four weeks, the staff have noticed progressive lethargy; John has also been experiencing up to six partial seizures daily, each lasting around 20 seconds.

These start as focal twitching in his right hand and extend up to the right side of his face. There has not been any associated loss of consciousness; however, John has been increasingly confused and is now unable to tolerate oral intake.

He has a background of dementia (Mini-Mental State Examination: 18/30), severe spine and knee osteoarthritis, gastro-oesophageal reflux disease, chronic constipation and non-alcoholic fatty liver disease.