Epilepsy - Complex partial seizure with secondary generalisation
Medication:
Levetiracetum (Keppra) 750mg mane and 1 gram note
Carbamazepine increased to 1000mg
Epistatus PRN
Allergies:
Penicillin
Sodium Valproate caused by hyperammonamia
Joey is seen under the Specialist Division for Learning Disabilities combined with the Jeffrey Resource Centre. Whenever an appointment is made with this division there are three types of assessments they need to make - Risks, Actions and a Summary.
(13th March 2015) Risks: No aggressive behaviour to note and none related to the dose of Levetiracetum. Treatment with Sodium Valproate resulted in hyperammonemia leading to the discontinuation of the drug. Actions: Community nurse support around communication between home and day centre still a problem. Joey to attend the day centre review to understand their barriers to maintaining a 1:1 session. Three month monitoring of the impact of stopping risperidone. Summary: Joey didn't attend the review meeting. Roumilla (centre carer) fed back on the impact of stopping risperidone. There were some indications of improvement with a marked decrease in repetitive questioning and other behaviours that challenge. The OT referral look at offering activities to distract from repetitive questioning was not made as Mrs Moss was unable to commit to additional support at present. This intervention may become unnecessary as stopping resperidone appears to have had a significant impact on the problem. Review will take place in three months time to fully assess the impact of stopping resperidone. This will be followed with a review of the epilepsy management plan.
(12 October 2015) Risks: Very rarely Joey will display aggressive behaviour and a significant episode occurred in 2009 under the dose of Levetiracetum reached 2000mg daily. Other episodes have occurred and these do not appear to have been related to the medication. Actions: Increase in dose of carbamazepine initially to 800mg mane and 1000mg nocte followed in four weeks with an increase to 1000m bd. Summary: There has been no significant change in seizure presentation, no deterioration in challenging behaviour; general physical health and quality of life remain good. Recommends further attempts to manage seizures using increased dose of the current epilepsy medication followed by a referral for a surgical opinion if seizures continue on a good dose of both current drugs.
Documents to support:
(10th June 2016) - Get to work interview review.
Summary: Patient has a severe learning disability, autism and epilepsy. He is not able to identify common dangers in the environment and can therefore not keep himself safe. He requires continuous supervision to remain safe and if not given prompt access to skilled care is at risk developing aggressive challenging behaviour. Regular planned activities in a variety of stimulating environments are an essential part of his care plan. While many adults with his level of mobility may be able to access such activities using public transport, this is not an option for Joey because of the risks associated with epilepsy and autism. In effect these impairments mean they while he may be able to walk he is unable to travel by any means other than car or minibus. These impairments are life long and will not improve with treatment.
Research:
Epilepsy: A condition that affects the brain and causes repeated seizures. It's estimated to affect more than 500,000 people int the UK. So almost 1 in every 100 people has the condition.
The seizures are the cells in the brain, known as neurones, they conduct electrical signals and communicate with each other in the brain using chemical messengers. During a seizure, there are abnormal bursts of neurones firing off electrical impulses, which can cause the brain and body to behave strangely. The severity of these seizures can differ from person to person. Some people simply experience an odd feeling with no loss of awareness, or may have a ''trance-like'' state for a few seconds or minutes, while others lose consciousness and have convulsions (uncontrollable shaking of the body).
Some people may only have a single seizure at some point during their life. If they do not have a high risk having further seizures, they would not be regarded as having epilepsy.
The pinpoint of epilepsy states that it can start at any age, but most often begins during childhood. It's often not possible to identify a specific reason why someone develops the condition, although - some cases - particularly those that occur later in life - are associated with damage to the brain. For example, epilepsy can be caused by strokes, brain tumours, and severe head injuries. Some cases of epilepsy may be caused by changes in the brain that occur as a result of the genes you inherit from your parents.
Autism Spectrum Disorder: A condition that affects social interaction, communication, interests and behaviour. The symptoms are present by three years of age, although diagnosis can sometimes be made after the age of three. It's estimated that 1 in every 100 people in the UK have ASD. There is no cure for ASD, but speech and language therapy, occupational therapy, educational support and a number of other interventions are available to help children and parents.
Signs and symptoms of ASD are having problems with social interactions and communications.
Being a carer for someone with ASD isn't an easy role. When you're busy responding to the needs of others it affects your emotional and physical energy, and can make it easy to forget your own health and mental wellbeing.
"Those who care for someone for 35 hours or more each week are eligible to claim Carer's Allowance, at a weekly rate of £62.10 - but it's been estimated that over the next four years carers face a £1bn cut to financial help" (1)
Other areas that need improvements include the quality of respite care and the number of respite homes. The department for Work and Pensions says 5,000 carers currently eligible for their weekly allowance will no longer be whrn personal independence payments replace the disability allowance. The changes are apparently necessary and 20,000 additional carers will gain, but Charity Carers UK claim that this is a 'cold comfort' to those who will actually miss out.
"More than a million people receive carer's allowance. And for about 270,000 of them, this entitlement is dependent on the eligibility for the disability living allowance (DLA) of someone of working age for whom they care. When DLA is replaced by the personal independence payment (PIP), there will be new rules and assessments to judge who can claim assistance to help them lead an independent life.
If fewer disabled people can claim PIP than are currently receiving DLA, this would have a knock-on effect for their carers. The DWP says about 76,000 disabled people with carers will be reassessed for PIP. It believes 25,000 of these people will no longer be entitled to DLA as a result, and their carer will also lose their allowance.
At the same time, another 20,000 carers will be newly awarded an allowance as a result of the PIP reassessment - meaning a net total of 5,000 carers who will miss out. But Carers UK says this estimate is too low. It says about 10,000 carers - 5,000 carers currently eligible under DLA and 5,000 "future" carers who would also have qualified under the DLA system - stand to lose.
Chief executive Helena Herklots said those families affected by these changes faced a double loss. "The government is now cutting financial support for carers by £31m - meaning that thousands of families now face the devastating double blow of disability and carers' benefits.
"This comes on top of cuts to social care services, cuts to housing benefit support for carers who need a separate room to sleep in, forthcoming reductions in support with council tax and thousands of carers who will have their benefits capped - a perfect storm of cuts to families already struggling to care for loved ones." The DWP said that it was investing more than before in carer's allowance - about £2bn.
A spokesman said: "We've also protected the link between carer's allowance and PIP entitlements, which has been welcomed by charities. "Furthermore, the universal credit will ensure that those carers on low incomes receive the support they need by allowing them to keep more of their own money as they move into work.
"It will also give carers more flexibility if they need carers breaks." (2)