hour long seizure-what was this?

I have seen my sister do something similar to what you are describing, although hers wasn't as predominantly one sided. She has MS. Symptoms were improved by and relieved with a benzo, can't remember which one now. If this gentleman has never had anything similar happen or has any other symptoms, an MRI would probably be a good idea.

Encephalopathy should show up on a CAT scan. The brains swelling makes pretty obvious changes to the image. Also if he had encephalopathy valium and ativan should not have fixed the problem as they don't decrease swelling.

You mention methadone for pain - that usually indicates chronic pain and/or drug use. If chronic pain could it be MS or spinal problems? You said labs were normal so I'm guessing no drugs other than methadone were found in his system? Had he missed any doses of his methadone - I've had pts with weird reactions who have been taken off methadone while in the hospital (even if given other pain meds methadone has a physical addictive property so it should be weaned slowly).

This is one of those fun/frustrating things about nursing - getting a patient who takes a bit to figure out.

Pat