This is is an online E log book to discuss our patient's deidentified health data shared after taking his/her/guardian's signed in formed consent.Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evideynce-based inputs.This e-log book also reflects my patient centered online learning protfolio and your valuable inputs on comment box is welcome A 30 yr old male who is a student resident of suryapet came to general medicine OPD with chief complaints of involuntary stiffening of left upper and lower limbs sence 18 yrs. HISTORY OF PRESENTING ILLNESS: Patient was apparently asymptomatic 18 yrs back then he started developing involuntary movements and stiffening of left upper and lower limbs associated with up rolling of eyes,froathing, headache,loss of language,fear, anxiety, apnea,stertoreus breathing,vocal