CHIEF COMPLAINT: prolonged seizure

PRESENT ILLNESS: The pt is a 51 year-old right-handed man with a history of
intractable complex partial epilepsy who presents with seizure .

MEDICAL HISTORY: PAST MEDICAL HISTORY:
-intractable complex partial epilepsy and likely secondary
generalized seizures since [**2163**]
* s/p cortical sectioning of epileptogenic focus: lower sensory
motor strip [**11/2165**],
* s/p left VNS [**6-/2170**], with VNS replacement [**8-18**]
- L4-5 disc herniation
* s/p left L4-5 hemilaminectomy, median facetectomy and L4-5
disketctomy [**10/2164**]
-chronic headaches
-sinusitis
-viral meningitis at age 13
-GERD
-HLD
-possible sleep apnea
-depression
-benign hematuria, kidney stones (thought to be [**2-19**] topamax)
- traumatic right third digit amputation, s/p re-attachment
PAST SURGICAL HISTORY
- cortical sectioning of epileptogenic focus: lower sensory
motor strip [**11/2165**],
- left VNS placement [**6-/2170**], with VNS replacement [**8-18**]
- left L4-5 hemilaminectomy, median facetectomy and L4-5
disketctomy [**10/2164**]
- tonsillectomy
- vasectomy
- attachment of right third digit s/p traumatic amputation

MEDICATION ON ADMISSION: - Lipitor 40 mg Qday
- Lamictal 200mg am and 300 mg at night
- Keppra [**2172**] TID
- Felbatol 1500mg/1500mg/1500mg
- Clarinex 5mg qday
- Zetia 10mg Qday
- Celexa 40 daily
- Omeprazole 20mg Qam
- ASA 81mg
- Metoprolol ER 50mg Qday
- Zantac 300mg QHS
- Ativan 1mg tid and prn

ALLERGIES: Dilantin Kapseal / Depakote / Tegretol / Codeine / Phenobarbital
/ Penicillins

PHYSICAL EXAM: Vitals: T:96.5  P:70  R:15  BP:127/73  SaO2:100%
General: Awake, cooperative, NAD.
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple. in C-collar
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities:warm and well perfused
Skin: no rashes or lesions noted.

FAMILY HISTORY: The patient reports that two of his children developed seizures
as infants, which resolved by six months of age.  Due to
adoption, the remainder of family history is unclear.

SOCIAL HISTORY: The patient lives with his wife.  Had worked as truck driver and
mechanic.  Reportedly, he has used cigarettes and pipes in the
past.  He enjoys alcohol occasionally. There is no history of
recreational drug use.
Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, with intractable epilepsy,Other specified paralytic syndrome,Esophageal reflux,Other and unspecified hyperlipidemia,Unspecified sleep apnea,Depressive disorder, not elsewhere classified,Personal history of urinary calculi,Other postprocedural status,Personal history of tobacco use,Personal history of venous thrombosis and embolism
Part epil w intr epil,Oth spcf paralytic synd,Esophageal reflux,Hyperlipidemia NEC/NOS,Sleep apnea NOS,Depressive disorder NEC,Prsnl hst urnr dsrd calc,Post-proc states NEC,History of tobacco use,Hx-ven thrombosis/embols
Admission Date:  [**2183-7-2**]              Discharge Date:   [**2183-7-6**]

Date of Birth:  [**2131-11-1**]             Sex:   M

Service: NEUROLOGY

Allergies:
Dilantin Kapseal / Depakote / Tegretol / Codeine / Phenobarbital
/ Penicillins

Attending:[**First Name3 (LF) 17813**]
Chief Complaint:
prolonged seizure

Major Surgical or Invasive Procedure:
none

History of Present Illness:
The pt is a 51 year-old right-handed man with a history of
intractable complex partial epilepsy who presents with seizure .

The patient reports that he was first
diagnosed with seizures in ~[**2163**].  The semiology has varied to
some degree over the years, with his current seizures consisting
of a prodrome of nausea.  Occasionally this will be all that he
experiences, however this will often progress to include right
arm and foot shaking, accompanied by a headache.  These will
generally last ~5-10 minutes.  He reports that he retains
consciousness throughout the episode, but does note that he is
quite tired afterwards, and will nap for 1-2 hours.

He was recently admitted last year to EMU and was in ICU for
control of his seizures. Since [**Month (only) 359**], he is on current AED
regime without any change. Per wife, he gets [**1-19**] seizures per
day
each lasting for 5-10 mins and usually would respond to 1-2 mg
of
PO ativan. They are Complex partial or right arm jerking. Roday
he was in the epilepsy clinic for follow up. When he was being
examined by [**First Name8 (NamePattern2) 16883**] [**Last Name (NamePattern1) 29298**], she noted sudden onset of right sided
arm jerking which lasted for at least 15 mins. He seemed
confused
and was not able to talk during that episode. She propmtly refd
him to ED where he required 6 mg of ativan to break the
seizures.
He was noted to be drowsy and was put on non rebreather for the
same. Next, neurology was called.

Over the years he has tried multiple medications, including
Tranxene, Phenobarbitol, Carbamazepine, Depakote, Neurontin,
Dilantin and Tegretol.


The patient reports a normal birth and developmental history,
and
denies any history of head trauma.  He does note that at age 13
he had viral meningitis.


Past Medical History:
PAST MEDICAL HISTORY:
-intractable complex partial epilepsy and likely secondary
generalized seizures since [**2163**]
* s/p cortical sectioning of epileptogenic focus: lower sensory
motor strip [**11/2165**],
* s/p left VNS [**6-/2170**], with VNS replacement [**8-18**]
- L4-5 disc herniation
* s/p left L4-5 hemilaminectomy, median facetectomy and L4-5
disketctomy [**10/2164**]
-chronic headaches
-sinusitis
-viral meningitis at age 13
-GERD
-HLD
-possible sleep apnea
-depression
-benign hematuria, kidney stones (thought to be [**2-19**] topamax)
- traumatic right third digit amputation, s/p re-attachment
PAST SURGICAL HISTORY
- cortical sectioning of epileptogenic focus: lower sensory
motor strip [**11/2165**],
- left VNS placement [**6-/2170**], with VNS replacement [**8-18**]
- left L4-5 hemilaminectomy, median facetectomy and L4-5
disketctomy [**10/2164**]
- tonsillectomy
- vasectomy
- attachment of right third digit s/p traumatic amputation

Social History:
The patient lives with his wife.  Had worked as truck driver and
mechanic.  Reportedly, he has used cigarettes and pipes in the
past.  He enjoys alcohol occasionally. There is no history of
recreational drug use.


Family History:
The patient reports that two of his children developed seizures
as infants, which resolved by six months of age.  Due to
adoption, the remainder of family history is unclear.


Physical Exam:
Vitals: T:96.5  P:70  R:15  BP:127/73  SaO2:100%
General: Awake, cooperative, NAD.
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple. in C-collar
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities:warm and well perfused
Skin: no rashes or lesions noted.

NEUROLOGICAL EVALUATION:
Mental Status: Awake, alert, and oriented to 'hospital' but not
the exact name.  Was able to get the year as [**2183**] but thought it
was [**Month (only) 404**].  Able to state the days of the week forward, but
not backwards.  She answers questions in an appropriate manner,
although is evasive when she does not know the answer.
Difficulty with low frequency objects calling my glasses
binoculars and knuckles as marks.  Speech is understandable but
dysarthric and simplistic. Repetition is intact to simple
phrases but omits words in complex phrases. She can follow
simple one step commands and moderately complex commands without
difficulty.

Cranial Nerves:
Pupils equal, round and reactive to light, visual
fields difficult to assess, but reacted to threat
visual acuity not assessed, extra ocular movements
intact and with nystagmus on left end gaze.  The face has
symmetric strength and sensation and the tongue, uvula and
palate are midline.
Hearing is grossly intact. Shoulder shrug is symmetric.

Motor: No pronator drift. Normal muscle bulk and tone.  No
fasciculations noted.  Full strength to confrontation
throughout.
No tremor.

Sensation:   Difficult to assess. She denies asymmetry to light
touch or vibration but also acknowledges the presence of
vibration after tuning fork has been stopped. Felt pinprick
throughout.

Reflexes: 2+ in the biceps, brachioradialis, and triceps muscles
bilaterally. Lower extremity was difficult to assess due to
noncooperation.  Even upon distraction she would flex and extend
her legs.  Toes withdraw bilaterally to babinski.

Coordination: Finger to nose intact.


Pertinent Results:
[**2183-7-2**] 02:45PM BLOOD WBC-8.3 RBC-4.14* Hgb-14.0 Hct-38.9*
MCV-94 MCH-33.9* MCHC-36.1* RDW-13.6 Plt Ct-303
[**2183-7-2**] 02:45PM BLOOD Neuts-63.6 Lymphs-28.2 Monos-5.3 Eos-1.5
Baso-1.4
[**2183-7-2**] 02:45PM BLOOD PT-11.3 PTT-25.1 INR(PT)-0.9
[**2183-7-2**] 02:45PM BLOOD Glucose-102* UreaN-13 Creat-0.8 Na-139
K-4.7 Cl-101 HCO3-27 AnGap-16
[**2183-7-3**] 03:35AM BLOOD Calcium-8.8 Phos-2.7 Mg-2.0

MICRO:
   URINE CULTURE (Final [**2183-7-4**]):
      GRAM POSITIVE BACTERIA.
         10,000-100,000 ORGANISMS/ML. Alpha hemolytic colonies
consistent
         with alpha streptococcus or Lactobacillus sp.

Brief Hospital Course:
51 yo RHM with h/o intractable partial complex epilepsy presents
with prolonged seizure witnessed in the [**Hospital 875**] Clinic.
The patient had continuous R arm and leg shaking for >30 minutes
in the [**Hospital 875**] Clinic, and was sent to the ED, where he
received Ativan and the seizure stopped.
He was admitted to the ICU for close monitoring, and the ability
to treat seizures aggressively if necessary.
In the ICU, he had several of his typical seizures- they are
characterized by R arm and leg shaking (sometimes spreads
slightly to the L leg), eyes are typically closed but can open
to command, and he remains unable to speak but can follow
midline commands and commands on the L side during the seizure.
He will be sleepy afterwards. Some of these events were treated
with Ativan, however given that they are his baseline type and
length of event, it was decided that it was safe to allow them
to break on their own.
He was discharged on his home AED regimen of Lamictal 200/300,
Keppra [**2172**] mg TID, felbamate 1500 mg TID and Ativan 1 mg TID
standing and prn.
He will follow up with Dr. [**Last Name (STitle) **].

Medications on Admission:
- Lipitor 40 mg Qday
- Lamictal 200mg am and 300 mg at night
- Keppra [**2172**] TID
- Felbatol 1500mg/1500mg/1500mg
- Clarinex 5mg qday
- Zetia 10mg Qday
- Celexa 40 daily
- Omeprazole 20mg Qam
- ASA 81mg
- Metoprolol ER 50mg Qday
- Zantac 300mg QHS
- Ativan 1mg tid and prn


Discharge Medications:
1. levetiracetam 500 mg Tablet Sig: Four (4) Tablet PO TID (3
times a day).
2. lorazepam 1 mg Tablet Sig: One (1) Tablet PO TID (3 times a
day).
3. lamotrigine 100 mg Tablet Sig: Two (2) Tablet PO QAM (once a
day (in the morning)).
4. lamotrigine 100 mg Tablet Sig: Three (3) Tablet PO QPM (once
a day (in the evening)).
5. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
6. citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

7. metoprolol succinate 50 mg Tablet Extended Release 24 hr Sig:
One (1) Tablet Extended Release 24 hr PO DAILY (Daily).
8. atorvastatin 40 mg Tablet Sig: One (1) Tablet PO once a day.

9. ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

10. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
11. felbamate 400 mg Tablet Sig: 3.75 Tablets PO TID (3 times a
day)

Discharge Disposition:
Home

Discharge Diagnosis:
epilepsy

Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.
Neuro Exam: normal exam

Discharge Instructions:
You were admitted for a prolonged seizure. You were monitored
and given Ativan as needed. You will be discharged on the same
medications for epilepsy.

Followup Instructions:
Please call to schedule an appointment with Dr. [**Last Name (STitle) **] in the
next few weeks.
{'Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, with intractable epilepsy,Other specified paralytic syndrome,Esophageal reflux,Other and unspecified hyperlipidemia,Unspecified sleep apnea,Depressive disorder, not elsewhere classified,Personal history of urinary calculi,Other postprocedural status,Personal history of tobacco use,Personal history of venous thrombosis and embolism'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: prolonged seizure

PRESENT ILLNESS: The pt is a 51 year-old right-handed man with a history of
intractable complex partial epilepsy who presents with seizure .

MEDICAL HISTORY: PAST MEDICAL HISTORY:
-intractable complex partial epilepsy and likely secondary
generalized seizures since [**2163**]
* s/p cortical sectioning of epileptogenic focus: lower sensory
motor strip [**11/2165**],
* s/p left VNS [**6-/2170**], with VNS replacement [**8-18**]
- L4-5 disc herniation
* s/p left L4-5 hemilaminectomy, median facetectomy and L4-5
disketctomy [**10/2164**]
-chronic headaches
-sinusitis
-viral meningitis at age 13
-GERD
-HLD
-possible sleep apnea
-depression
-benign hematuria, kidney stones (thought to be [**2-19**] topamax)
- traumatic right third digit amputation, s/p re-attachment
PAST SURGICAL HISTORY
- cortical sectioning of epileptogenic focus: lower sensory
motor strip [**11/2165**],
- left VNS placement [**6-/2170**], with VNS replacement [**8-18**]
- left L4-5 hemilaminectomy, median facetectomy and L4-5
disketctomy [**10/2164**]
- tonsillectomy
- vasectomy
- attachment of right third digit s/p traumatic amputation

MEDICATION ON ADMISSION: - Lipitor 40 mg Qday
- Lamictal 200mg am and 300 mg at night
- Keppra [**2172**] TID
- Felbatol 1500mg/1500mg/1500mg
- Clarinex 5mg qday
- Zetia 10mg Qday
- Celexa 40 daily
- Omeprazole 20mg Qam
- ASA 81mg
- Metoprolol ER 50mg Qday
- Zantac 300mg QHS
- Ativan 1mg tid and prn

ALLERGIES: Dilantin Kapseal / Depakote / Tegretol / Codeine / Phenobarbital
/ Penicillins

PHYSICAL EXAM: Vitals: T:96.5  P:70  R:15  BP:127/73  SaO2:100%
General: Awake, cooperative, NAD.
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple. in C-collar
Pulmonary: Lungs CTA bilaterally without R/R/W
Cardiac: RRR, nl. S1S2, no M/R/G noted
Abdomen: soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted.
Extremities:warm and well perfused
Skin: no rashes or lesions noted.

FAMILY HISTORY: The patient reports that two of his children developed seizures
as infants, which resolved by six months of age.  Due to
adoption, the remainder of family history is unclear.

SOCIAL HISTORY: The patient lives with his wife.  Had worked as truck driver and
mechanic.  Reportedly, he has used cigarettes and pipes in the
past.  He enjoys alcohol occasionally. There is no history of
recreational drug use. 

### Response:
{'Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, with intractable epilepsy,Other specified paralytic syndrome,Esophageal reflux,Other and unspecified hyperlipidemia,Unspecified sleep apnea,Depressive disorder, not elsewhere classified,Personal history of urinary calculi,Other postprocedural status,Personal history of tobacco use,Personal history of venous thrombosis and embolism'}
