Epilepsy Consultation (Inpatient-first visit)

ADMISSION NOTE The patient was informed that an AI-assisted scribe was used for documentation purposes, and consent was obtained. Date: 1 November 2024, Friday Patient name and DOB: Sarah Jenkins, 15/03/1990 ICD-10 code: G40.109 Patient Summary: 34-year-old female with focal epilepsy of unknown aetiology, admitted for inpatient video-EEG monitoring to better characterise her seizure semiology and assess for potential surgical candidacy. Current anti-seizure medications: 1. Levetiracetam 1000mg twice daily 2. Lamotrigine 200mg twice daily Previous anti-seizure medications: 1. Valproate (discontinued due to significant weight gain and hair loss) Risk factors for epilepsy: History of complicated febrile seizures in childhood (age 3). No family history of epilepsy. No significant head trauma or history of meningitis/encephalitis. History of epilepsy illness: Age of onset 12 years. Initially treated with carbamazepine, then switched to valproate, and currently on levetiracetam and lamotrigine. Seizure types include focal aware seizures with motor features (right arm jerking) and focal to bilateral tonic-clonic seizures. Aura: Patient reports a sensation of déjà vu and an ascending epigastric discomfort prior to motor symptoms. Ictus: Characterised by sudden cessation of activity, staring, followed by repetitive right arm jerking for approximately 30-45 seconds, occasionally evolving into a bilateral tonic-clonic seizure. Post-ictal: Confusion and fatigue lasting 15-30 minutes after focal aware seizures. Significant post-ictal lethargy and headache after focal to bilateral tonic-clonic seizures. Duration: Focal aware seizures typically last 1-2 minutes. Focal to bilateral tonic-clonic seizures last 2-3 minutes. Frequency: Approximately 2-3 focal aware seizures per month, and 1 focal to bilateral tonic-clonic seizure every 2-3 months despite current medication regimen. Previous investigations: 1. MRI brain (10/05/2023) - Reported as normal, no structural lesions identified. 2. Routine EEG (22/07/2023) - Showed intermittent left temporal sharp waves. Past medical/surgical history: - Migraines, managed with sumatriptan as needed. - Appendectomy (age 10). Allergies: Penicillin (rash). Social history: Works as an accountant. Lives with partner. Occasional alcohol use (1-2 units per week). No recreational drug use. Non-smoker. Physical exam: General: Alert and oriented, cooperative. No acute distress. Cranial Nerves: Intact. Pupils equal, round, and reactive to light. Extraocular movements full. Facial sensation symmetric. Gag reflex present. Motor: Normal tone and strength (5/5) in all four limbs. No pronator drift. No asterixis. Sensory: Intact to light touch, pinprick, vibration, and proprioception. Coordination: Normal finger-to-nose and heel-to-shin. No dysdiadochokinesia. Reflexes: Biceps, triceps, brachioradialis, patellar, and ankle jerks 2+ bilaterally and symmetric. Plantar reflexes downgoing bilaterally. Cerebellar: Normal gait. No ataxia. Plan: 1. Continue current anti-seizure medications. 2. Inpatient video-EEG monitoring to capture typical seizures and localise seizure onset zone. 3. Discuss findings with patient and family following monitoring, including potential surgical options if indicated.