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ON 10/10/16
• IV PROPOFOL WAS DISCONTINUED IN VIEW OF BRADYCARDIA AND PRIS. STARTED ON IV
MIDAZOLAM 30MG/HR (DOUBLE STRENGTH)
ON 11/10/16
• EEG: DOCUMENTED CLINICAL AND ELECTROGRAPHIC SEIZURES ORIGINATE FROM RIGHT
TEMPORAL THEN GENERALIZED TO LEFT SIDE WITH BURST SUPPRESSION PATTERN BUT NOT
LONG ENOUGH
• NO IMPROVEMENT DESPITE COMPLETED IVIG AND IV METHYLPREDNISOLONE FOR 5/7.
• TREATED AS NORSE
• STARTED ON IV PHENOBARBITONE 90MG/HR THEN IVI PHENOBARBITONE 0.5MG/KG/HR
(22MG/HR)
• HAD ANOTHER FEW EPISODES OF SEIZURE AND LOADED WITH IV PHENOBARBITONE 60MG/HR
AND INCREASED IVI PHENOBARBITONE TO 1MG/KG/HR (44MG/HR) AND INCREASED IVI
MIDAZOLAM 40MG/HR (20ML/HR)
• 12/10/16,
• EEG: NO MORE CLINICAL SEIZURE. MORE BACKGROUND SUPPRESSION BUT STILL CANNOT
ACHIEVE TARGET OF 6 SEC SUPPRESSION.
• GIVEN IV PHENOBARBITONE BOLUS 50MG X3
• INCREASED IVI PHENOBARBITONE TO 150MG/HR (3.5MG/KG/HR)
• PERCUTANEOUS TRACHESOTOMY WAS DONE IN VIEW OF PROLONGED VENTILATION
ON 13/10/16,
• AUTOIMMUNE WORKUP: NEGATIVE
• EEG: BURST SUPPRESSION 4-5 SECONDS
• TDM PHENOBARBITONE: 101.3
• CONTINUE IVI PHENOBARBITONE 150MG/HR
ON 14/10/16
• EEG: BURST SUPPRESSION 5-6 SECONDS (ON IVI PHENOBARBITONE 150MG/HR)
• DECREASED IV PHENOBARBITONE 120MG/HR
ON 15/10/16
• TDM PHENOBARBITONE 218.8
• DECREASED IVI PHENOBARBITONE 80MG/HR
ON 16/10/16
• TDM PHENOBARBITONE 197.3
• DECREASED IVI PHENOBARBITONE TO 50MG/HR
ON 17/10/16
• ABLE TO OFF IVI PHENOBARBITONE. STARTED ON MAINTENANCE IV PHENOBARBITONE 60MG
TDS
ON 23/10/16
• FIT FREE SINCE 17/10/16 AND THEN NOTED HAD FASCICULATION OF TONGUE AND LEFT SIDE
JERKING OF FACE, LEFT LOWER LIMBS AND UPPER LIMBS
• STARTED BACK IVI PHENOBARBITONE 0.5MG/KG/HR (22MG/HR)
ON 24/10/16,
• LOADED WITH IV PHENOBARBITONE 225MG
• INCREASED IVI PHENOBARBITONE 88MG/HR (2MG/KG/HR)
ON 26/10/16
• STILL HAVING SPIKE OF FEVER. NO SEIZURE.
• CT TAP: NO MALIGNANCY
• CONTINUE IVI PHENOBARBITONE 88MG/HR (2MG/KG/HR)
ON 27/10/16,
• EEG: SLOW THETA WAVE, BURST SUPPRESSION < 1 SEC. NO CLINICAL SEZURE
• CONTINUE IVI PHENOBARBITONE 88MG/HR (2MG/KG/HR)
ON 28/10/16
• EEG: BURST SUPPRESSION. NO CLINICAL SEIZURE
• TDM PHENOBARBITONE: 240
• DECREASED IVI PHENOBARBITONE 66MG/HR (1.5MG/KG/HR)
ON 30/10/16
• TDM PHENOBARBITONE: 270
• REDUCED IVI PHENOBARBITONE 44MG/HR (1MG/KG/HR)
ON 31/10/16
• TDM PHENOBARBITONE: 250
• REDUCED IVI PHENOBARBITONE 22MG/HR (0.5MG/KG/HR)
ON 2/11/16
• FITTED 2 EPISODE
• ON IVI PHENOBARBITONE 44MG/HR (1MG/KG/HR)
• TDM PHENOBARBITONE: 194.6
• GIVEN IVI PHENOBARBITONE 44MG/HR (1MG/KG/HR)
HDW
ON 14/11/16
• TDM PHENOBARBITONE: 187
• CONTINUE IVI PHENOBARBITONE 66MG/HR (1.5MG/KG/HR)
• INCREASED PERAPAMEL 6MG ON AND T. TOPIRAMTE 100MG OM, 200MG ON
ON 21/11/16
• OFF IVI PHENOBARBITONE
• CHANGED TO T. PHENOBARBITONE 480MG TDS
ON 24/11/16
• TDM PHENOBARBITONE: 236.8
• DECREASED T. PHENOBARBITONE 360MG TDS
ON 28/11/16
• NOTED MACULOPALPULAR RASH OVER TRUNL/ABDOMEN/ ANTERIOR CHEST WALL
• STOPPED PHENYTOIN. (SUSPECT CAUSE OF RASH)
• REDUCED T. PHENOBARBITONE 120MG TDS
ON 2/12/16
• REDUCED T. PHENOBARBITONE 60MG TDS
ON 11/12/16
• ANOTHER EPISODE OF SEIZURE.
• IV PHENOBARBITONE 200MG BOLUS
• INCREASED T. PHENOBARBITONE 120MG TDS
ON 12/12/16
• ANOTHER BOLUS OF IV PHENOBARBITONE 200MG
• CONTINUE T. PHENOBARBITONE 120MG TDS
ON 13/12/16
• INCREASED T. PHENOBARBITONE 180MG TDS
• INCREASED T. TOPIRAMATE 400MG OM, 200MG ON
ON 15/12/16
• HAD SEIZURE. LIP SMACKING NOTED (?AUTOMATISM)
• STARTED T. LQCOSAMIDE LOADING 400MG STAT AND 100MG BD
ON 18/12/16
• HAVING ORAL DYSKINESIA
• INCREASED T. LACOSAMIDE 150MG OM, 100MG ON
ON 29/12/16
• INCREASED T. LACOSAMIDE 150MG BD
NEUROMEDICAL WARD
ON 6/1/17
• TRANSFERRED TO NEUROMEDICAL WARD
• EEG (12/1/17): BACKGROUND SLOWING OF THETA RANGE, LEFT TEMPORAL DISCHARGE BUT
LESSER COMPARED TO PREVIOUS
• NO MORE SEIZURE.
• TRANSFERRED TO KOTA BELUD HOSPITAL FOR CONTINUATION OF CARE
DISCHARGE MEDICATIONS:
• T. TOPIRAMATE 200MG BD
• T. LACOSAMIDE 150MG BD
• T. EPILIM 800MG TDS
• T. PHENOBARBITONE 180MG TDS
• T. KEPPRA 150MG BD
No. Date Seizure Medication Remarks
1 4/10/16 Seizure IV epilim 900mg loading
T. Epilim 200mg TDS
2 5/10/16 Seizure IV Keppra 1g loading
T. Keppra 1g BD
3 6/10/16 Seizure IV Epilim 900mg loading
↑ T. Epilim 400mg TDS
Seizure IV Phenytoin 750mg loading
IV Phenytoin 100mg TDS
4 7/10/16 IVIG 18g OD Cover for autoimmune
IV Methylprednisolone 1g OD encephalitis
5 8/10/16 Seizure IV Propofol 10ml/hr
6 9/10/16 Seizure T. Topiramate 20mg BD
7 10/10/16 Seizure Off iV Propofol Discontinued in view of
PRIS and bradycardia
↑ T. Perapamel 6mg ON
↑ T. Topiramte 100mg OM, 200mg ON
MRA brain
13/10/16 USG abdomen Ascites
IVC thrombosis
Urinary bladder debris
26/10/16 CT TAP Lung changes in keeping with active infection
Hepatomegaly. No focal lesiom
17/11/16 USG abdomen No evidence of collection
28/11/16 MRI brain Reduced signal intensity in DW1 sequence indicates response to treatment
Cerebral atrophy