CHIEF COMPLAINT: Increased seizure frequency.

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: ADMISSION PHYSICAL EXAM:
Physical Exam:
General: drowsy
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity
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: No C/C/E bilaterally, 2+ radial, DP pulses
bilaterally.
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.  Mother living,
age 76 with a history of MI and uterine cancer.  Father died at
age 64 of a stroke and MI

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 complex partial seizures, with intractable epilepsy,Paroxysmal ventricular tachycardia,Esophageal reflux,Other and unspecified hyperlipidemia,Depressive disorder, not elsewhere classified,Obstructive sleep apnea (adult)(pediatric)
Psymotr epil w intr epil,Parox ventric tachycard,Esophageal reflux,Hyperlipidemia NEC/NOS,Depressive disorder NEC,Obstructive sleep apnea
Admission Date:  [**2183-7-24**]              Discharge Date:   [**2183-8-14**]

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

Service: NEUROLOGY

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

Attending:[**First Name3 (LF) 5167**]
Chief Complaint:
Increased seizure frequency.

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.

On neuro ROS, the pt denies headache, loss of vision, blurred
vision, diplopia, dysarthria, dysphagia, lightheadedness,
vertigo, tinnitus or hearing difficulty. Denies difficulties
producing or comprehending speech.  Denies focal weakness,
numbness, parasthesiae. No bowel or bladder incontinence or
retention. Denies difficulty with gait.

On general review of systems, the pt denies recent fever or
chills.  No night sweats or recent weight loss or gain. Denies
cough, shortness of breath.  Denies chest pain or tightness,
palpitations.  Denies nausea, vomiting, diarrhea, constipation
or
abdominal pain.  No recent change in bowel or bladder habits.
No
dysuria.  Denies arthralgias or myalgias. Denies rash.



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.  Mother living,
age 76 with a history of MI and uterine cancer.  Father died at
age 64 of a stroke and MI


Physical Exam:
ADMISSION PHYSICAL EXAM:
Physical Exam:
General: drowsy
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity
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: No C/C/E bilaterally, 2+ radial, DP pulses
bilaterally.
Skin: no rashes or lesions noted.

Neurologic:
-Mental Status: drowsy and doesnt answer the questions of
oreintation. Inattentive, follows commands both midline and
appendicular. Speech was not dysarthric.  There was no evidence
of apraxia or neglect.

-Cranial Nerves:
I: Olfaction not tested.
II: PERRL 3 to 2mm and brisk.  VFF to confrontation. Funduscopic
exam revealed no papilledema, exudates, or hemorrhages.
III, IV, VI: EOMI without nystagmus.  Normal saccades.
V: Facial sensation intact to light touch.
VII: No facial droop, facial musculature symmetric.
VIII: Hearing intact to finger-rub bilaterally.
IX, X: Palate elevates symmetrically.
[**Doctor First Name 81**]: 5/5 strength in trapezii and SCM bilaterally.
XII: Tongue protrudes in midline.

-Motor: Normal bulk, tone throughout. No pronator drift
bilaterally.
No adventitious movements, such as tremor, noted. No asterixis
noted.
  Delt Bic Tri WrE FFl FE IO IP   Quad   Ham TA [**First Name9 (NamePattern2) 2339**] [**Last Name (un) 938**] EDB
L  5    5   5     5   5  5  5  5    5    5   5     5     5   5
R  4+    4+  4+   5   5  5  5  4+   5    4+  5     5     5   5

-Sensory: No deficits to light touch, pinprick, cold sensation,
vibratory sense, proprioception throughout. No extinction to
DSS.


-DTRs:
  [**Name2 (NI) **] Tri [**Last Name (un) 1035**] Pat Ach
L  1  1    1    1   1
R  1  1    1    1   1
Plantar response was mute bilaterally.

-Coordination: No intention tremor, no dysdiadochokinesia noted.
No dysmetria on FNF or HKS bilaterally.

-Gait: Defd

DISCHARGE PHYSICAL EXAM:
Physical Exam:
General: drowsy
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity
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: No C/C/E bilaterally, 2+ radial, DP pulses
bilaterally.
Skin: no rashes or lesions noted.

Neurologic:
-Mental Status: drowsy, but AAOx3. Inattentive, follows commands
both midline and appendicular. Speech was not dysarthric.  There
was no evidence
of apraxia or neglect.

-Cranial Nerves:
I: Olfaction not tested.
II: PERRL 3 to 2mm and brisk.  VFF to confrontation. Funduscopic
exam revealed no papilledema, exudates, or hemorrhages.
III, IV, VI: EOMI without nystagmus.  Normal saccades.
V: Facial sensation intact to light touch.
VII: No facial droop, facial musculature symmetric.
VIII: Hearing intact to finger-rub bilaterally.
IX, X: Palate elevates symmetrically.
[**Doctor First Name 81**]: 5/5 strength in trapezii and SCM bilaterally.
XII: Tongue protrudes in midline.

-Motor: Normal bulk, tone throughout. No pronator drift
bilaterally.
No adventitious movements, such as tremor, noted. No asterixis
noted.
  Delt Bic Tri WrE FFl FE IO IP   Quad   Ham TA [**First Name9 (NamePattern2) 2339**] [**Last Name (un) 938**] EDB
L  5    5   5   5   5  5  5  5    5       5   5     5     5   5
R  5    5   5   5   5  5  5  5    5       5   5     5     5   5

-Sensory: No deficits to light touch, pinprick, cold sensation,
vibratory sense, proprioception throughout. No extinction to
DSS.

-DTRs:
  [**Name2 (NI) **] Tri [**Last Name (un) 1035**] Pat Ach
L  1  1    1    1   1
R  1  1    1    1   1
Plantar response was mute bilaterally.

-Coordination: No intention tremor, no dysdiadochokinesia noted.
No dysmetria on FNF or HKS bilaterally.

-Gait: Defd


Pertinent Results:
ADMISSION LABS:

[**2183-7-24**] 07:30PM BLOOD WBC-8.8 RBC-4.44* Hgb-14.1 Hct-40.4
MCV-91 MCH-31.7 MCHC-34.8 RDW-13.8 Plt Ct-313
[**2183-7-24**] 07:30PM BLOOD Glucose-103* UreaN-10 Creat-0.7 Na-142
K-4.1 Cl-105 HCO3-29 AnGap-12
[**2183-7-26**] 07:24AM BLOOD ALT-22 AST-23 CK(CPK)-59 AlkPhos-99
TotBili-0.4
[**2183-7-24**] 07:30PM BLOOD Calcium-9.6 Phos-3.5 Mg-1.8

DISCHARGE LABS:

[**2183-8-14**] 06:26AM BLOOD WBC-7.3 RBC-3.69* Hgb-12.1* Hct-35.2*
MCV-96 MCH-32.9* MCHC-34.4 RDW-13.9 Plt Ct-346
[**2183-8-14**] 06:26AM BLOOD Glucose-115* UreaN-15 Creat-0.7 Na-141
K-4.1 Cl-104 HCO3-29 AnGap-12
[**2183-8-14**] 06:26AM BLOOD ALT-26 AST-26 AlkPhos-81 TotBili-0.2
[**2183-8-14**] 06:26AM BLOOD Calcium-8.9 Phos-4.0 Mg-1.8

REPORTS:

[**2183-7-25**] EEG: IMPRESSION: This 24-hour video EEG telemetry
captured several
pushbutton activations without a clear electrographic correlate.
There
do not appear to be any epileptiform discharges associated with
these
events. The higher amplitude and more sharply contoured rhythm
seen
over the left temporal region likely represents a breech
artifact with
the patient's known left craniotomy.

[**2183-7-26**] EEG: IMPRESSION: This is an abnormal continuous ICU
monitoring study because of intermittent focal slowing and
breach artifact over the left frontotemporal region, consistent
with the patient's history of prior
surgery and multiple subpial transections in this region.
Excessive
diffuse beta activity was present, likely secondary to
benzodiazepine
effect. There are 3 reported clinical seizures consisting of
prolonged
right hand jerking. However, the patient was off camera for all
3 of
these episodes, and no ictal EEG change was seen during the
pushbutton
activations. Only 20-30% of simple partial seizures will have an
ictal
EEG correlate visible on scalp EEG.

[**2183-7-27**] EEG: IMPRESSION: This is an abnormal continuous ICU
monitoring study because of intermittent focal slowing and
breach artifact over the left frontotemporal region, consistent
with the patient's history of prior
surgery and multiple subpial transections in this region.
Excessive
diffuse beta activity is present, likely secondary to
benzodiazepine
effect. There are 4 pushbutton events for 3 reported clinical
seizures
consisting of prolonged right hand jerking. The clinical
manifestations
of the seizures were not well-seen, but there was occasional
right hand
jerking. No ictal EEG change was seen during the pushbutton
activations.
Only 20-30% of simple partial seizures will have an ictal EEG
correlate
visible on scalp EEG. Compared to the previous day's recording,
there
was no significant change.

[**2183-7-28**] EEG: IMPRESSION: This is an abnormal continuous ICU
monitoring study because of intermittent focal slowing and
breach artifact over the left frontotemporal region, consistent
with the patient's history of prior
surgery and multiple subpial transections in this region.
Excessive
diffuse beta activity is present, likely secondary to
benzodiazepine
effect. Compared to the previous day's recording, there were no
clinical seizures reported.

[**2183-8-1**] ECHO: Conclusions
The left atrium is mildly dilated. There is mild symmetric left
ventricular hypertrophy. The left ventricular cavity size is
normal. Due to suboptimal technical quality, a focal wall motion
abnormality cannot be fully excluded. Overall left ventricular
systolic function is normal (LVEF 70%). The ascending aorta is
mildly dilated. The aortic valve leaflets (3) appear
structurally normal with good leaflet excursion and no aortic
stenosis or aortic regurgitation. The mitral valve appears
structurally normal with trivial mitral regurgitation. The
estimated pulmonary artery systolic pressure is normal. There is
no pericardial effusion.
IMPRESSION: Suboptimal image quality. Left ventricular function
is grossly well-preserved. However, the right ventricle was
poorly visualized. Right ventricular structural pathology cannot
be excluded on the basis of this examination (cardiac MRI
recommended for this purpose).


Brief Hospital Course:
[**Known firstname **] [**Known lastname **] is a 51 yo R-handed man with a history of
intractable complex partial epilepsy who presented with seizures
from an OSH after attempts to stop his seizures with ativan and
clonazepam were unsuccessful and he required further management.
 Neurological exam revealed some difficulty with repetition and
intermittent R-sided weakness, which pt reports is his baseline.
 His course was complicated by an ICU transfer necessary for
monitoring after large amounts of ativan were given for
seizures,and overnight on [**7-22**] by NSVT and transient
hypotension.  He was transferred out of the ICU on [**2183-8-1**], and
was since stable on the floor with intermittent seizures.  He
was monitored while his medications were adjusted for better
seizure control.  He eventually was essentially at his baseline
for seizures and was able to be sent home after he was cleared
to do so by PT.
.
# NEURO: pt has known complex partial epilepsy that was recently
poorly controlled on his medications prior to admission.  His
VNS was interrogated while here and while initially it was set
too low, it is now functioning appropriately.  Pt's seizures on
this admission were initially ranging anywhere from 20 mins to
over 1 hour, and did not seem to be broken with ativan or VNS
swipes.  With adjustment of his medications and VNS settings,
they began to range more from 15-30 mins and were occuring
2-3x/day, which pt reports is his baseline.  We increased pt's
ativan to 2mg PO every 4 hours, and added vimpat 250mg [**Hospital1 **] to
his medication regimen.  We also increased his felbamate to
1800/1800/1500mg TID.
.
# PULM: patient has known hx of OSA, so while here we kept him
on a CPAP on autoset per respiratory therapy recs.  He did not
require intubation during this admission.
.
# CARDS: we had some concern of insular involvement of his
seizures vs med side effect (ie QTc prolongation) given 1x
episode of NSVT and transient hypotension during his ICU
transfer, but QTc was stable at 413, and PR interval remained
WNL.  He had no significant events noted on telemetry.  We
continued pt on his atorvastatin, ezetemibe and instead of pt's
home dose of metoprolol succinate we gave him the equivalent
dose of [**Hospital1 **] dosed metoprolol tartrate.
.
# GI: pt w/ known GERD, so we continued his home dose
omperazole.
.
#CODE/CONTACT: full code (confirmed with pt); wife [**Name (NI) **] [**Name (NI) **]
[**Name (NI) **] [**Telephone/Fax (5) 94761**]

PENDING RESULTS: None

TRANSITIONAL CARE ISSUES:
It will need to be ensured that pt is able to walk at home
safely without significant risk of fall.

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. atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

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

4. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
5. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
6. metoprolol succinate 50 mg Tablet Extended Release 24 hr Sig:
One (1) Tablet Extended Release 24 hr PO once a day.
7. lamotrigine 100 mg Tablet Sig: 2-3 Tablets PO twice a day:
Please take 200mg in the morning and 300mg at night.
Disp:*150 Tablet(s)* Refills:*2*
8. lorazepam 1 mg Tablet Sig: Two (2) Tablet PO Q4H (every 4
hours).
Disp:*360 Tablet(s)* Refills:*2*
9. Keppra 1,000 mg Tablet Sig: Two (2) Tablet PO four times a
day: One dose must be given at midnight.
Disp:*240 Tablet(s)* Refills:*2*
10. felbamate 400 mg Tablet Sig: 4.5 Tablets PO twice a day: Pt
is to take 1800mg QAM, 1800mg QNoon and 1500mg QPM.
Disp:*270 Tablet(s)* Refills:*2*
11. felbamate 600 mg Tablet Sig: 2.5 Tablets PO QPM: Pt is to
take 1800mg QAM, 1800mg Qnoon and 1500mg QPM.
Disp:*75 Tablet(s)* Refills:*2*
12. lacosamide 100 mg Tablet Sig: 2.5 Tablets PO once a day.
Disp:*75 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary: Seizures
Secondary: Obstructive Sleep Apnea


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Lethargic but arousable.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).

NEURO EXAM: Intermittent RUE weakness after a seizure


Discharge Instructions:
Dear Mr. [**Known lastname **],
You were seen in the hospital for increased seizure frequency.
While you were here we monitored your seizures on EEG and
changed many of your medications.  Once your seizures were under
better control we were able to send you home.

We made the following changes to your medications:
1) We STARTED you on LAMOTRIGINE 200mg in the morning and 300mg
in the evening.
2) We INCREASED your KEPPRA to 2,000mg four times a day.
3) We INCREASED your FELBAMATE to 1800/1800/1500mg three times a
day.
4) We INCREASED your ATIVAN to 2mg every 4 hours.
5) We STARTED you on LACOSAMIDE 250mg twice a day.

Please continue to take your other medications as previously
prescribed.

If you experience any of the below listed Danger Signs, please
call your doctor or go to the nearest Emergency Room.

It was a pleasure taking care of you on this hospitalization.

Followup Instructions:
Department: NEUROLOGY
When: THURSDAY [**2183-8-21**] at 9:45 AM
With: [**First Name8 (NamePattern2) 539**] [**Last Name (NamePattern1) 6531**] RN [**Telephone/Fax (1) 876**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 858**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: NEUROLOGY/[**Hospital Ward Name **] 503
When: THURSDAY [**2183-8-21**] at 11:00 AM
With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD [**Telephone/Fax (1) 5285**]
Building: Ba [**Hospital Unit Name 723**] ([**Hospital Ward Name 121**] Complex) [**Location (un) **]
Campus: WEST     Best Parking: [**Street Address(1) 592**] Garage
{'Localization-related (focal) (partial) epilepsy and epileptic syndromes with complex partial seizures, with intractable epilepsy,Paroxysmal ventricular tachycardia,Esophageal reflux,Other and unspecified hyperlipidemia,Depressive disorder, not elsewhere classified,Obstructive sleep apnea (adult)(pediatric)'}


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: Increased seizure frequency.

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: ADMISSION PHYSICAL EXAM:
Physical Exam:
General: drowsy
HEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in
oropharynx
Neck: Supple, no carotid bruits appreciated. No nuchal rigidity
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: No C/C/E bilaterally, 2+ radial, DP pulses
bilaterally.
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.  Mother living,
age 76 with a history of MI and uterine cancer.  Father died at
age 64 of a stroke and MI

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 complex partial seizures, with intractable epilepsy,Paroxysmal ventricular tachycardia,Esophageal reflux,Other and unspecified hyperlipidemia,Depressive disorder, not elsewhere classified,Obstructive sleep apnea (adult)(pediatric)'}
