Epilepsy Care Plan Document

Paediatrician's Note - 1 November 2024 Epilepsy Care Plan Document Patient Information: Sarah Jenkins, 8 years old, female. Lives with parents and younger brother. Diagnosed with epilepsy at age 5. Epilepsy Diagnosis & Other Diagnosis: Right frontal lobe epilepsy, primarily presenting with focal aware seizures with motor symptoms (clonic movements of left arm). Diagnosis confirmed 15/03/2019. Diagnostic Studies: Recent EEG (20/09/2024) showed focal epileptiform discharges over the right frontal region. MRI (01/08/2024) showed no structural abnormalities. Current medication - Levetiracetam (Keppra) 250mg, twice daily (250mg morning, 250mg evening) - Vitamin D supplement, 400 IU, once daily Emergency: One emergency room visit on 10/10/2024 for prolonged focal seizure (12 minutes), resolved spontaneously prior to administration of rescue medication. No hospital admission required. Rescue Medication Protocol: - If a Generalised Tonic Clonic Seizure lasts for 5 minutes or longer, give 5mg Buccal Midazolam (Buccolam). - If a focal seizure lasts for 15 minutes or longer, give 5mg Buccal Midazolam (Buccolam). - If 3 seizures occur in 30 minutes, give 5mg Buccal Midazolam (Buccolam). Once given please place in the recovery position and call an ambulance. Background and birth history Born full term via vaginal delivery. No perinatal complications. Met all developmental milestones within expected ranges. No significant early childhood illnesses. Past Medical History History of recurrent otitis media (resolved). No other significant medical history or surgical interventions. Current Seizure Activity: Reports 2-3 focal aware seizures per week, typically lasting 30-60 seconds, involving clonic movements of the left arm. Occasional post-ictal fatigue. No generalised tonic-clonic seizures in the last 6 months. Seizure Triggers: Parents report seizures are often triggered by sleep deprivation (less than 8 hours of sleep) and high-stress situations (e.g., school exams). Flashing lights are not identified as a trigger. Medication Adherence: Parents report excellent adherence to Levetiracetam. Medication is given consistently with meals. No reported missed doses. Side Effects: Patient reports occasional mild irritability, particularly in the evenings, which is managed by parents with structured routines and early bedtime. No other significant side effects noted. Seizure Action Plan: Parents instructed to time seizures. If seizure lasts longer than 15 minutes or if 3 seizures occur within 30 minutes, administer Buccal Midazolam as per protocol and call emergency services. Patient to wear medical alert bracelet at all times. Lifestyle Modifications: Emphasised importance of consistent sleep schedule (aim for 9-10 hours nightly). Discussed stress reduction techniques for Sarah (e.g., deep breathing exercises). Encouraged regular, moderate physical activity. Safety Precautions: Supervision during swimming and bathing. Cycling permitted with helmet. No driving restrictions applicable at this age. School nurse informed of epilepsy and rescue medication protocol. Follow-up Plan: Next appointment scheduled for 1 February 2025 (3 months). Continue daily seizure diary. Follow-up EEG may be considered in 12 months. Coordinated care with school and primary care physician. Emergency Contacts: Dr. Emily Green (Paediatric Neurologist): 020 7123 4567 Local NHS Direct: 111 Emergency Services: 999 Goals and Objectives: Short-term: Reduce focal seizure frequency by 50% within 3 months. Improve coping strategies for stress. Maintain excellent medication adherence. Long-term: Achieve seizure freedom. Support normal development and participation in school activities. Transition to adult epilepsy care when appropriate. Patient Education: Discussed seizure first aid, the importance of medication adherence, identifying and managing triggers, and when to administer rescue medication. Provided written information on epilepsy and local support groups.