Additional information received from the provider indicated that the patient experienced a temporary breakthrough in seizures, attributed the patient's start of menses and birth control medication, on or around (b)(6) 2015.The overall seizure frequency of the breakthrough seizures was back to, but not above, pre-vns level.It was reported that the patient had experienced weight gain (not vns-related) that may have also contributed to the breakthrough seizures in the opinion of the provider.The breakthrough seizures were not related to vns.During the temporary breakthrough seizures the patient experienced one extended duration seizure of 30 min for which the magnet was attempted 14 times but did not abort the seizure.This extended seizure was also attributed to the patient's menses start, birth control medication start with recent weight gain being another possible contributing factor.The extended seizure was not related to vns.On (b)(6) 2015 the patient's vns parameters were changed in an attempt to achieve increased efficacy; normal and magnet output current were each increased one step to 2.25ma and 2.75ma, respectively.Off time was increased from 1.8 min to 3 min.Normal vns function was observed at this visit with diagnostics within normal limits.The provider stated that the patient has not reported any seizures since the (b)(6) visit.It was noted that the patient is on several anti-seizure medications and 2-3 adhd medications and the provider stated belief that birth control medication can negatively impact anti-seizure medication efficacy.
|