Epilepsy Case Criteria

The offender is in clinic today after she had an apparent seizure on 12/31 in the evening. She had an ICS activated at that time. It is not clear exactly what she was doing but she fell onto the floor and scraped the side of her face on the right side abrading it on the rug or something. Since then she has been putting bacitracin on the area. She says that she missed a couple doses of Keppra prior to the incident. She says she was not trying to skip the medication or get off of it she simply forgot to take it. She normally takes 500 mg twice a day. She has had a seizure disorder since birth. Her last seizure was when she was in Waseca at the Federal Program. She was returned here due to her medical complications including her epilepsy and thyroid condition. She has been hyperthyroid. She was last seen for that in early December and she has a repeat visit coming up soon for that disorder. She denies any pain or numbness, weakness, or tingling currently. She had complained of a headache the evening after the seizure but has been doing well otherwise. She is in school and she says she took a sick today because of her face.

OBJECTIVE
Her vital signs are normal. Weight is 170 pounds. The HEENT exam shows her fundi are benign. Pupils and EOMS are intact. She has a fairly large linear
abrasion that starts in her right temple and eyebrow and comes down across her right cheek and across the philtrum of her upper lip that is red and nasty looking. She has desquamated the surface of the skin. The ears, nose and throat are negative. Her tongue is atraumatic. Her neck is normal. Chest is clear and equal. Cardiovascular exam is normal. Her abdomen and back are benign and extremities are negative. The neuro exam is intact including her reflexes and gait.

ASSESSMENT
Generalized seizure due to epilepsy and medication noncompliance.

PLAN
I talked this over with the offender, if she had not missed doses of Keppra she would need an increase in her drug order, but she does admit to missing doses and likely that set her up for the event.
In which case, we will check a Keppra level this week and I will plan to see her back in clinic in about two weeks. In the meanwhile, I recommended to her that she take her medication religiously and not miss doses so she does not have a seizure and injure herself worse than she did this time. She verbalized understanding of that. I did advise her that the episode is unrelated to her thyroid disorder. She knows she can kite or sign up for sick call if she needs
to.