Health Problem???
Health Problem???EEG Examination
Akira was reviewed in clinic today for his seizure disorder.
As you know, he had some type of brain tumor removed at the age of four in Hong Kong. Prior to this, he had multiple seizures. The seizures stopped with his surgery. He was well until December 1996 when he developed an apparent generalized seizure. He was seen by physicians at that time and was started on a variety of medications including Dilantin, Frisium and Lamtical. This did put an end to his generalized seizures but he has continued to have apparent partial complex seizure four to seven times per month. He says that he stares often into space and is not able to communicate. For a few minutes afterwards, he is rather confused.
He reports side effect with all of his antiepileptic medications. He has developed significant gingival hyperplasia with the Dilantin and he feels the rest if them make him tired. He has not noticed a rash or excessive sedation with Lamtical or frisium respectfully. Carbamazepine was recently added. He is not sure if this made any difference but has not noted any side effects.
Neurologic Review of Systems: he has had a watering eye on the right side since his surgery.
Past Medical History: As above.
Medications: Dilantin 330mg per day, Lamtical 200 mg per day, Frisium 10 mg per day, Carbamazepine 200 mg per day.
Allergies: He may have had some type of allergic reaction to one of his antiepileptics but he is not sure which one.
Social history: This gentleman smokes but does not drink.
Family history: Non-Contributory.
Review of systems: Non-Contributory.
Examination: Mental status was nomal. Visual fields were full and pupil were symmetrical. Discs were crisp. He had a right exotropia. There was no nystagmus. Face was symmertrical and hearing was okay. Speech was clear. Detailed assessment of strength was normal in the upper and lower limbs. Reflexes were slightly brisker on the right (Surprisingly) then the left. Plantars were down going. Cortical sensation was normal as was coordination. Romberg was negative and no drift was noted. Gait and tandem gait were normal.
Assessment: Mr. Lee clearly has complex partial seizures arising from cortical damage secondary to his old tumor. At this point, his seizure control is suboptimal. I have chosen to steadily increasing his frisium to 20 mg per day. Once this is done, we can give some consideration to cutting back on his Carbamazepine and possibly his Dilantin. I would be in favor of trying to push Lamtical and Frisium until he either gets better or he develops toxic side effects. I typically try to avoid more than three anticonvulsants in any one particular paitent. If we are not able to get a good seizure control utilizing medical therapy, he may be considered a candidate for surgical therapy. I have organized an EEG for this gentleman and will contiune to follow him at regular intervals.
I hope this information proves useful.
考試: 精神狀態是nomal 。視野是充分的並且學生是對稱的。圓盤是酥脆的。他有一正確的exotropia 。沒有眼顫。面孔是symmertrical 並且聽力是好。講話是清楚的。對力量的詳細的評估是正常的在上部和更低的肢體。反射是輕微地輕快的在右邊(驚奇) 然後剩下。Plantars 是在去下。表皮感覺像協調是正常的。Romberg 是消極的並且漂泊不是著名。步態和縱排步態是normal.
Assessment: 李先生清楚地有複雜部份奪取出現從表皮損傷次要對他的老腫瘤。這時, 他的奪取控制是最適度一下的。我選擇了對平穩地增加他的frisium 對2 0 毫克每天。一旦這做, 我們能給予一些考慮削減在他的Carbamazepine 和可能他的Dilantin 。我會是傾向於設法推擠Lamtical 和 Frisium 直到他或者得到更好或他開發毒性副作用。我典型地設法避免超過三anticonvulsants 在所有一特殊paitent 。如果我們不能得到好奪取控制運用醫療療法, 他也陶Q認為一名候選人為外科療法。我組織EEG 使這紳士和意志contiune 跟隨他在正則區間。
我希望這資訊證明有用。
August 26, 2002File No. EEG-02-754EEG Laboratory.
Dr. Brad Stewart
Electroencephalogram
the record reveals symmetrical irregular moderate amplitude reactive 10 hz occipital alpha activity. Lower amplitude 14-25 hz waves are seen in the frontal regions and centrally moderate amplitude 8-12 hz waves predominate. The amplitudes are sightly higher at the site of the previous craniotomy. Some sharp waves are noted over the right hemispheric leads and at times 4-8 hz waves in the same location arise. At times some 1-3 hz waves of moderate amplitude occur for longer intervals over the right temporal region. Hyperventilation and photic stimulation do not yield additional information.
紀錄顯露對稱不規則的適度高度易反應的10 赫茲occipital 阿爾法活動。更低的高度14-25 赫茲波浪看在前面地區並且在中心適度高度8-12 赫茲波浪佔優勢。高度是悅目的更高在早先顱骨切開術的站點。一些鋒利的波浪是著名在正確的半球主角並且4-8 赫茲波浪在同樣地點時常升起。適度高度大約1-3 赫茲波浪時常發生為更長的間隔時間在正確的世俗區域。換氣過度和光斬的刺激不產生其它資訊。
IMPRESSION: dysrhythmia grade 2, maximum right temporal. The record is abnormal and demonstrates intermittent slowing and some sharp waves in the right hemisphere, maximally in the temporal region. This is suspicious for a lowered seizure threshold but frank epileptic activity is not identified.
印象: dysrhythmia 等級2, 最大正確世俗。紀錄是反常的和展示斷斷續續減慢和一些鋒利的波浪在正確的半球, 最大地在世俗區域。這是疑神疑鬼為被降下的奪取門限但直率癲癇的活動不被辨認。
As you know, he had some type of brain tumor removed at the age of four in Hong Kong. Prior to this, he had multiple seizures. The seizures stopped with his surgery. He was well until December 1996 when he developed an apparent generalized seizure. He was seen by physicians at that time and was started on a variety of medications including Dilantin, Frisium and Lamtical. This did put an end to his generalized seizures but he has continued to have apparent partial complex seizure four to seven times per month. He says that he stares often into space and is not able to communicate. For a few minutes afterwards, he is rather confused.
He reports side effect with all of his antiepileptic medications. He has developed significant gingival hyperplasia with the Dilantin and he feels the rest if them make him tired. He has not noticed a rash or excessive sedation with Lamtical or frisium respectfully. Carbamazepine was recently added. He is not sure if this made any difference but has not noted any side effects.
Neurologic Review of Systems: he has had a watering eye on the right side since his surgery.
Past Medical History: As above.
Medications: Dilantin 330mg per day, Lamtical 200 mg per day, Frisium 10 mg per day, Carbamazepine 200 mg per day.
Allergies: He may have had some type of allergic reaction to one of his antiepileptics but he is not sure which one.
Social history: This gentleman smokes but does not drink.
Family history: Non-Contributory.
Review of systems: Non-Contributory.
Examination: Mental status was nomal. Visual fields were full and pupil were symmetrical. Discs were crisp. He had a right exotropia. There was no nystagmus. Face was symmertrical and hearing was okay. Speech was clear. Detailed assessment of strength was normal in the upper and lower limbs. Reflexes were slightly brisker on the right (Surprisingly) then the left. Plantars were down going. Cortical sensation was normal as was coordination. Romberg was negative and no drift was noted. Gait and tandem gait were normal.
Assessment: Mr. Lee clearly has complex partial seizures arising from cortical damage secondary to his old tumor. At this point, his seizure control is suboptimal. I have chosen to steadily increasing his frisium to 20 mg per day. Once this is done, we can give some consideration to cutting back on his Carbamazepine and possibly his Dilantin. I would be in favor of trying to push Lamtical and Frisium until he either gets better or he develops toxic side effects. I typically try to avoid more than three anticonvulsants in any one particular paitent. If we are not able to get a good seizure control utilizing medical therapy, he may be considered a candidate for surgical therapy. I have organized an EEG for this gentleman and will contiune to follow him at regular intervals.
I hope this information proves useful.
考試: 精神狀態是nomal 。視野是充分的並且學生是對稱的。圓盤是酥脆的。他有一正確的exotropia 。沒有眼顫。面孔是symmertrical 並且聽力是好。講話是清楚的。對力量的詳細的評估是正常的在上部和更低的肢體。反射是輕微地輕快的在右邊(驚奇) 然後剩下。Plantars 是在去下。表皮感覺像協調是正常的。Romberg 是消極的並且漂泊不是著名。步態和縱排步態是normal.
Assessment: 李先生清楚地有複雜部份奪取出現從表皮損傷次要對他的老腫瘤。這時, 他的奪取控制是最適度一下的。我選擇了對平穩地增加他的frisium 對2 0 毫克每天。一旦這做, 我們能給予一些考慮削減在他的Carbamazepine 和可能他的Dilantin 。我會是傾向於設法推擠Lamtical 和 Frisium 直到他或者得到更好或他開發毒性副作用。我典型地設法避免超過三anticonvulsants 在所有一特殊paitent 。如果我們不能得到好奪取控制運用醫療療法, 他也陶Q認為一名候選人為外科療法。我組織EEG 使這紳士和意志contiune 跟隨他在正則區間。
我希望這資訊證明有用。
August 26, 2002File No. EEG-02-754EEG Laboratory.
Dr. Brad Stewart
Electroencephalogram
the record reveals symmetrical irregular moderate amplitude reactive 10 hz occipital alpha activity. Lower amplitude 14-25 hz waves are seen in the frontal regions and centrally moderate amplitude 8-12 hz waves predominate. The amplitudes are sightly higher at the site of the previous craniotomy. Some sharp waves are noted over the right hemispheric leads and at times 4-8 hz waves in the same location arise. At times some 1-3 hz waves of moderate amplitude occur for longer intervals over the right temporal region. Hyperventilation and photic stimulation do not yield additional information.
紀錄顯露對稱不規則的適度高度易反應的10 赫茲occipital 阿爾法活動。更低的高度14-25 赫茲波浪看在前面地區並且在中心適度高度8-12 赫茲波浪佔優勢。高度是悅目的更高在早先顱骨切開術的站點。一些鋒利的波浪是著名在正確的半球主角並且4-8 赫茲波浪在同樣地點時常升起。適度高度大約1-3 赫茲波浪時常發生為更長的間隔時間在正確的世俗區域。換氣過度和光斬的刺激不產生其它資訊。
IMPRESSION: dysrhythmia grade 2, maximum right temporal. The record is abnormal and demonstrates intermittent slowing and some sharp waves in the right hemisphere, maximally in the temporal region. This is suspicious for a lowered seizure threshold but frank epileptic activity is not identified.
印象: dysrhythmia 等級2, 最大正確世俗。紀錄是反常的和展示斷斷續續減慢和一些鋒利的波浪在正確的半球, 最大地在世俗區域。這是疑神疑鬼為被降下的奪取門限但直率癲癇的活動不被辨認。
posted by Careless Whisper @ 21:06
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