Neurology Follow-Up

December 6, 2011

Neurology Follow-up

Eleanor Gifford

DOB:

The patient came with her significant other. She has been calling a lot recently, states she has had more episodes. A long story but when she uses oxygen with a small nasal cannula she doesn't have any events but she can't use that with her CPAP machine and she cant' get oxygen on a regular basis because she doesn't have documented hypoxemia. It is not that she wants the oxygen as much as she wants the nasal cannula that only comes with the oxygen. She has talked this over with Dr. Butlin who is also working on it.

I find no changes in exam. I must admit I am not certain if all or any of these episodes represent seizure. We repeated her baseline EEG. It was done about a week ago and showed just bilateral, non-specific slowing.

I am reluctant to increase her anticonvulsant therapy. Since she is having these episodes frequently, an ambulatory EEG might catch one, so we are going to try to do that through Dr. Lieberman's office, twenty-four or forty-eight hour EEG continuously. Discussed at length with the patient and her significant other. We will recheck here as planned in a couple of weeks.

James J. Gilbert, MD

JJG:aeh

T: 121211

Cc: Dr. Butlin

ADDENDUM: Before we refer her to an epilepsy center for video monitoring and all, I think it would be difficult for the patient, and I think since we really don't suspect these episodes are seizure, it probably would not be a practical recommendation at this time. We can always readdress that later.