Kaden Colson

projected schedule for AFCH EMU 11/30-12/5/2016

dat
e

day

anticipated meds

11/2
9

Tuesday
pre-admit
home

11/3
0

Wednesda
y
admission

12/0
1

Thursday

12/0
2

Friday

12/0
3

Saturday

12/0
4

Sunday

12/0
5

Monday

Depakote:
1000 1250
Keppra:
1500 2250
perampanel:
0 -8
clonazepam:
0.5
0.75
Depakote:
750 750
Keppra:
1500 1500
perampanel:
0 -8
clonazepam:
0.5
0.75
Depakote:
500 500
Keppra:
1500 1500
perampanel:
0 -8
clonazepam:
0.5
0.75
Depakote:
250 250
Keppra:
1500 1500
perampanel:
0 -?
clonazepam:
0.5
0.75
Depakote:
0 - 250
Keppra:
1500 1500
perampanel:
0-?
clonazepam:
0.5
0.75
Depakote:
-0Keppra:
1500 1500
perampanel:
0-?
clonazepam:
0.5
0.75
Depakote:
-0Keppra:
1500 -

comments

Admission labs to include CBC w/

platelets, VPA and Keppra levels.
If he takes VPA 1000mg at home,
simply continue the schedule as
written after admission

If no seizures that show focus,

reduce perampanel to 6 mg/day

If no seizures that show focus,

reduce Keppra to 750 - 1000

V. Gibbons
11/28/16

12/0
6

Tuesday
In OR
grid&depth
s
placed

1500
perampanel:
0-?
clonazepam:
0.5
0.75
likely to be NPO

V. Gibbons
11/28/16

From: RAHEEL AHMED [mailto:raheel.ahmed@neurosurgery.wisc.edu]

Sent: Monday, November 28, 2016 9:34 AM
To: Struck Aaron; Vincent Gibbons; McLennan Lisa; SUSAN GORDON HUBANKS; Michor Laura L
Subject: RE: KC

Aaron, yes that is the plan. He still has frequent breakthrough szs on meds. I need to get the valproate
off, since it has been known, but admittedly not completely agreed, to cause Perioperative bleeding
problems. It would be safer to do this in an inpatient setting. If possible , we can wean some of the
other meds too to try and elicit a typical sz. he has never had a prototypical sz captured on VEEG.
Raheel
-------- Original message -------From: AARON F STRUCK <struck@neurology.wisc.edu>
Date: 11/28/16 9:13 AM (GMT-06:00)
To: RAHEEL AHMED <raheel.ahmed@neurosurgery.wisc.edu>, Vincent Gibbons
<gibbons@neurology.wisc.edu>, Lisa McLennan <mclennan@neurosurgery.wisc.edu>, SUSAN
GORDON HUBANKS <hubanks@neurosurgery.wisc.edu>, Michor Laura L <llt2@hosp.wisc.edu>
Subject: Re: KC Vince and Raheel,

Am I understanding the e-mail thread correctly? Is Kody going to be admitted for medication taper and vEEG
monitoring prior to implantation?
Thanks,
Aaron
From: RAHEEL AHMED
Sent: Monday, November 28, 2016 9:04:32 AM
To: Vincent Gibbons; Lisa McLennan; SUSAN GORDON HUBANKS
Cc: AARON F STRUCK
Subject: RE: KC
I am meeting Aaron and the EEG techs tomorrow at 1pm in the EEG lab to review some of the
procedural details, mapping etc. Would you like to join in?
Also, I had emailed Fred, since he was listed on call for the inpatient service and he is available to
assist too. But, since you are available and on call for the EMU, it would be great to have you organize
this all.
I am planning 2 depth electrodes in the lesion. Perhaps 2 in the temporal lobe, if so indicated by the
MEG.
The MEG report should be available by Wed or Thurs. I'll let you know as soon as I get it.
Thank you Raheel
-------- Original message -------From: Vincent Gibbons <gibbons@neurology.wisc.edu>
Date: 11/28/16 8:48 AM (GMT-06:00)
To: RAHEEL AHMED <raheel.ahmed@neurosurgery.wisc.edu>
Cc: AARON F STRUCK <struck@neurology.wisc.edu>
Subject: RE: KC
Thanks for putting this plan together and filling me in on the details.

Could you please clarify the following:

1. Who will be staffing the EMU ie on EEG call during 11/30 to 12/6?
2. Who can assist with drug weaning ?

V. Gibbons
11/28/16

3. Aaron is on EEG call for the 12/6 to 12/13 and I have contacted him to assist with the grid
monitoring.

Ill be staffing the pediatric EMU from 11/30-12/6 and will keep you and Aaron informed of
progress. Ive been very pleased at the teamwork among the pediatric and adult EEG readers,
and will continue to analyze the pre-op EMU studies along with them.
I dont know how long it might be before we get the report of the MEG being done in Milwaukee
today, but would appreciate having access to it when it arrives, so we can insert it into the plan
that we discussed earlier this fall, and into the ongoing pre-op EMU recordings this week.
Ill orchestrate the AED weaning and be sure that the valproic acid is stopped before December
6. Well work with the inpatient pediatric team this week so everyone will know the plan and
rationale.
Present AEDs:
o divalproex:
1000 1250
VPA level 92 mcg/ml on 10/6;
INR 1.1, PTT 30,
platelets 135k on 11/16
o Keppra:
1500 2250
o perampanel:
0 - 8 mg
o clonazepam:
0.5 - 0.75
I look forward to associating with Aaron for the grid interpretation 12/6 12/13. Will there be
any mapping over that period? Are depth electrodes in the posterior frontal and/or anterior
parietal areas planned?
Regards,
V. Gibbons
From: RAHEEL AHMED
Sent: Sunday, November 27, 2016 5:01 PM
To: Vincent Gibbons <gibbons@neurology.wisc.edu>
Subject: KC

Kaden Colson
2956822
Vince,
Kaden is scheduled for grid implantation on Tues Dec 6th with resection on Dec 13th. As you
may recall, his EEG studies were non localizing. In addition, an inpatient VEEG session from
4/4/16 to 4/8/16 with drug weaning elicited a seizure but it could not be localized either.
To help with grid implantation and pre surgical localization:
1. I have him scheduled for an MEG study on 11/28 in Milwaukee.
2. Admit him to EMU at AFCH on 11/30 and undertake one more VEEG with drug withdrawal.
The admission has already been arranged.
3. At a minimum, I would like to withdraw valproate completely because of its bleeding
complications during/after surgery. Given his seizure history, it would be prudent to do this in
an inpatient setting.
Could you please clarify the following:
1. Who will be staffing the EMU ie on EEG call during 11/30 to 12/6?
2. Who can assist with drug weaning ?
3. Aaron is on EEG call for the 12/6 to 12/13 and I have contacted him to assist with the grid
monitoring.
I am in the OR on Mon morning and early afternoon, but I can touch base on the phone or
meet after 3pm or so.
Thank you,
Raheel

V. Gibbons
11/28/16