**INSTITUTION **INSTITUTION **NAME[AAA, BBB CCC] Daily progress note MR# **ID-NUM Case# **ID-NUM

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Date of services: Friday, **DATE[Jul 20 2000] 12:50 **INSTITUTION day #7. **AGE[in 30s] years old with intractable epilepsy who
presented in status epilepticus s/p VNS and corpus callosotomy, currently on 4 AED. Subjective: VNS was reprogrammed to
lowest settings yesterday. No acute events overnight. No movements while asleep. Awake and alert early this AM. PE:
General: in bed; well appearing; no obvious distress; Neuro MS: arouses to noxious stimuli LANGUAGE/SPEECH: patient nonverbal CNs: PERRL; face symmetric MOTOR: arms
twitching while awake; normal tone; moves all four extremities to noxious stimuli  SENSORY: moves all four extremities to noxious stimuli COORDINATION: unable to assess GAIT: unable to assess
Medications: - enoxaparin for dvt prophylaxis 40 mg subcut 1st stat qday 10 - lorazepam inj: ativan 2 mg iv prn -
topiramate: topamax 200 mg po 1st stat tid - agitation sedation score misc rass target as of **DATE[Jul 15 07] 08:44 : 0 alert
and calm - pregabalin: lyrica 75 mg po q12h - levetiracetam: keppra 1750 mg po q12h - lamotrigine: lamictal 150 mg po
q12h - lorazepam: ativan 2 mg po q4h Labs: None today


Imaging: EEG (**DATE[Jul 18 2007]): Clinical Interpretation: This abnormal EEG is consistent with a symptomatic generalized
epilepsy (modified by corpus callosotomy) or multifocal partial epilepsy. Repeat EEG with video to focus on the
movements in question might be useful. No ictal discharges were seen. Assessment: Ms. **NAME[AAA] is a **AGE[in 30s] year old female who presented to the Vanderbilt ER in status epilepticus. EEG was
consistent with a symptomatic generalized epilepsy; will do video EEG if she starts having movements again. However,
treatment team does not feel her extremity movements represent seizure activity since they cease when she is asleep.
Therefore, it is more likely a reaction to her meds; will continue to taper off the Lyrica step-wise and watch for
response. VNS reprogrammed yesterday. Dr. **NAME[ZZZ] updated with changes. Plan : 1. Continue Lyrica 75mg po BID (for now)
2. Increase Lamictal to 200mg po BID 3. Continue Topamax 200mg po TID and Keppra 1750mg po BID 4. Decrease Ativan to 2mg
q4h and switch from IV to po 5. Txf to floor today 6. Continue Lovenox for DVT prophylaxis The patient was discussed
with Dr. **NAME[YYY], with whom this plan was jointly developed.

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Written by: Best, **NAME[XXX], M.D.