Diagnoses:

Epilepsy, unspecified; Dyslexia; Complex Strabismus

Summary:

The client is a young female, who, according to previous documentation, was diagnosed with grand mal seizures approximately three years prior to referral to MRC. The initial seizure was immediately after a varicella vaccination and first presented to a pediatric neurologist at the age of nine years. For the first two years the client was having seizures three times per year increasing to monthly for the past year, with a change in character to a complex partial pattern. When the client has a seizure, she reportedly becomes unconscious, her body becomes limp, she is amnestic, and holds her breath and cries in the post-ictal stage (after the seizure). She was started on anti-epileptics in June 2012 without significant improvement. The client has had MRIs in the past that showed questionable asymmetry of the hippocampi. The treating neurologist continued to change medication dosages with little to no improvement in the client’s seizure activity.

The MRC Nurse Consultant discussed with the client’s parents the option of seeking a second opinion, which they agreed to pursue. The MRC Nurse Consultant researched the Seattle Children’s Hospital Epilepsy Program and assisted the family with coordinating care at Seattle Children’s Hospital and obtaining free air travel with Angel Flight. The client underwent neuropsychological testing at Seattle Children’s Hospital on February 14, 2013, and was admitted on February 19, 2013, for inpatient evaluation and continuous EEG monitoring. After the complete evaluation, a medication weaning plan was recommended by the neurologist and this recommendation was given to the client’s pediatric neurologist. The client has been weaned off the seizure medication and there have been no episodes of unconscious-type activity requiring medical attention. The client was experiencing extreme fatigue with unconscious activity lasting up to four hours. The neurologist opined that the client was being administered too much seizure medications and felt a slow weaning process should be implemented, along with further evaluation. The EEG at Seattle Children’s Hospital did not rule out a diagnosis of epilepsy, but the neurologist felt it made the diagnosis less likely.

As of April 9, 2013, there was no new seizure activity reported except some dizziness described by the client. The client has decreased fatigue and states to be doing much better at school. The last reported seizure was January 17, 2013.

Cost Savings:

1. The MRC Nurse Consultant was instrumental in coordinating care for the client’s seizure activity, as prolonged unconsciousness puts a patient at risk for brain injury, this intervention was vital. The MRC Nurse Consultant assisted the client in obtaining a second opinion at Seattle Children’s Hospital where the neurologist believed the client needed to wean seizure medications.

• A minimum of three emergency room visits for a moderate to high level of care for seizure activity were avoided ($2,677 x 3)

Avoided ER Visits: $8,031

2. Due to the MRC Nurse Consultant arranging for a second opinion, it was determined the medication the client was taking was no longer necessary and was discontinued.

• 6 months of medication costs saved ($847.20/month)

Medication Savings: $5,083

3. The MRC Nurse Consultant made arrangements with Angel Flight to transport the client and a parent at no charge to Seattle for the evaluation.

Cost of travel from Soldotna, AK to Seattle: $ 1,274

Total Cost Savings: $ 14,838