Neurology Follow up – 2 seizures later
JULY 12, 2011
APPOINTMENT IN THE NEUROLOGY CLINIC WITH DR. JOSEPH AT CHILDRENS HOSPITAL OF WISCONSIN ON JULY 12, 2011.
1) Ryan’s weight today is 25 lbs. 11 oz. His height is 33 ½ inches.
2) Since last seen in the Neurology Clinic, Ryan has had 2 seizures.
3) Suzanne is the nurse for Dr. Joseph. She took a thorough history, asked about recent seizures, meds, etc.
4) Dr. Joseph said she is concerned that vomiting is a part of Ryan’s seizures because he could choke. She said his seizures are not under control yet, as Keppra is not doing the job. She speculated that something is happening while he is sleeping. Robin reported that after his seizures, Ryan regresses/ a bit, developmentally. Dr. Joseph said that until his seizures are under control, calling 911 or going to the ER may be necessary and not an over reaction.
5) Dr. Joseph said Ryan’s seizures are probably towards the back of his head. All his EEG’s have been normal. She explained the only way an EEG can indicate a seizure is if the seizure is happening during the testing or the EEG can show “silent” seizures. The EEG does not show past seizures on the recordings.
6) Dr. Joseph said there are no seizure monitors that could alert you as to if a seizure is occurring. An apnea monitor could indicate breathing problems. She said there are seizure dogs that alert others if someone is having a seizure.
7) Dr. Joseph said a seizure disorder is the same as epilepsy and with Ryan’s seizure history, he would be considered having epilepsy.
8) So the main goal is to get Ryan’s seizures under control. Dr. Joseph is making the following recommendations:
a) Schedule an MRI in 3 months
b) Prescribe a suction machine for use during episodes of seizures
c) Schedule an appointment in the Sleep Clinic
d) Talk to your pediatrician if you want to order a sleep apnea monitor
e) Schedule an in-home overnight EEG. You would go to a clinic to get hooked up with the apparatus and then go home to sleep
f) Get a Keppra blood level today. Keppra dose will be increased to 3.5 ml., 2 times a day, once in the am and once in the pm.
g) Schedule a follow up visit with Dr. Joseph in 6 months
h) Start a new anti-seizure medication, Lamactil, to be taken in conjunction with the Keppra. There is no generic for Lamactil, so need to take the brand name. The Lamactil will be a 5 mg. chewable tablet that can be put in ice cream or other foods. Possible side effects include insomnia or a rash, so the dose will slowly be increased in the future, as tolerated. If a rash occurs, call Dr. Joseph or the Dermatology clinic. Lamactil takes 3-4 months to show in the blood level.