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HomeMy WebLinkAbout99-00966 >- "I r::: !?; C',; ;< I-' :::) - c' ~ r-) .--.... UJ~,:,"_ ~~~ ~d'r') :.--:: '~~i ~$~l.; Cc.. :'~J " , O~.;~ c::> ~<~ l':":'~- '..-, '..." 0:: 1.'_,1 0:.1 ~~ t..:...1 ~: ,j F':: l>- .,~ LL.. 'T"o :.::J 0 01 U ,', ", \.\ '. ' ,.,'. ' ',..' ,: '. " ~.; ':, "\~. : ':.\ ".\':'-' ,l .'\ " ': ,'/".' .:";"~': ~'..':":'.';:', I~":"'I:'~',:" '. " '( , M.... "I' \ ... . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF TRANSPORTATION Bureau or Drlver Licensing Moll Dote: January 19, 1999 rccaIszr , " " I' I I i t i l ANNA NIEVES 627 HOOT OWL ROAD ROILING SPGS PA 17007 Dcar Ms, ANNA NlliVRS: We have received medical information indicating that you have a Seizure Disorder condition which prevenls YOII from safely operating 11 motor vehicle. . . __ , " .. ^s of 02123/1999, you ffillY no longer drive. Your driving privilege is hereby recalled indefinitcly as mandated by Scction 1519(c) Or the Vehicle Code, This decision has heen made hy comparing your medicul condition with the standards , recommended by our Medical Advisory Board and adopted by this Department. This-action will remain in effectllntil we receive medicul information that your condition has improved and YOll are ahle to safely operate a motor vehicle. Since you have a seizure disorder, YOll mllst remain seizure free for a six month period, with or without medicution, he fore YOll will be eligible for reinstatement of your driving privilege. QUI' records indicale that your sei7.ure occurred 'In 12l!.~!.98. .c. Tn order to comply with this action. you are required to return any'eull'ent driver's license. learner's permil, andlor tcmporary driver's license (camera card) in YOllr possession no later than the cffective date listed ahove. If you cannot comply with the requirements Slaled above, you are required to suhmit a D1.-16LC Form or a sworn affidavit stating that you are aware of the sanction against YOllr driving privilege. When the Department receives your license or affidavit, we will send YOll a receipt. You have Ihe righllo uppeal to the Court of Common Pleas of the county of your residence within thirly (30) days of the mail date of this notice. You still must send in your license before the effective dale of suspcllsiollunless you appear in person before a judge and receive all order pcnl1itting you to cOlllil1LlC driving. ( ( , ',' , , ....,.. ,..._.._.._.-,...~ , After the appcal has been filed in the County Court, a time-stamped certified copy of the appeal mUSl he sent by cenified mail to: , '.. ,____pennsylvania Department of Transportation Offiee of Chief Counsel Third Floor, Riverfront Office Center Harrisburg, PA 17104 If you have any queslions or need further infonnation, please contact the Medical Unit, P.O. Box 68682, Harrisburg, PA 17106-8682 or call (717) 787-9664 or (717) 787-9662 between the houn; of 8:00 a.lll, and 4::10 p.m. Sincerely, ~~\~ '. .."..' .- Rebecca L. Bickley, Director Bureau of Driver Licensing Driver Liccnse #: 19784862 ... _, _0.__,. , __4 ,.0; ," ~!,~a'38~d l~lOl ** ... ......... I'...... , r. , .~. 1.'121 \T.971 ItA." ~ CONVULSIVE DISORDER REPORTiNG FORM I'~l~ " ,.uzm F-IIT Bureau 01 Driver Wo.n.'ng Driver Qualifl.al,on S<<tion P,O. aox 118882 Harrisburg, PA 17106-8882 17m 787.9862 PATIENT INFORMATION HEIG~ III ~. JR erc FIRST NAME AN rJA OAT! OF giRTH TE,EPHONE NUMee~ ,:,;';;00 '[;,'0('1/'1 l;{Sg-OSI ..., Q () ST e zlPcoce \LINiS~~IN6 r.:l ,iOO'l ,. Hae the patient been diagnosed as having II seizure disorder. ? ...............................................................)ZJ a II yes, date of last ePisode?.-l~ gq, 2. Has the patient had an EEG? 11 yes. date of EEG ~c~lL~ .......................... Q CJ Indicative of seizure pattern? ,..,................................,....................,............:......................................,.............. a Q '8 Q SEX eve COLOR ORlvER'S LICENSE NO, 3. Is the patient being treated With medication? 11 yes. type and dosage Q Does the medication affect the patient's ability to safely operate a motor vehicle? ..................,................ a 4. OOBS the Plltient have seizure episodes attributable to a prescribed change in or removallrom medication? ,.......................,........................................"........."................................................... CJ sa II yes. date of last episode? _ ___ Hes Ihe original medlcallon been reintroduced? ......................,..................................................................... 1:1 0 5. Ooes the patienl have seizure episodes always preceded by a specifio prolonged aura? ........................,a Q II yes. what Is the duration of the aura? ~, .. ,.\u. How is it manifested? -'1::)\ ~3 ~.~ I ~~\;(~ How long has Ihe patient experienced this aura?" c:l V ,,~ 6. Does the patient experience only an aura? ......................,..:.................................................................... Q tS: How long hilS the palient experienced this aura? . 7. ~:~~ :~a ~:~~:~;~ ~~. ,~..~,~~~~r.~..~~.~~~~~~,~, ,~.~~~~~~~, ~~~~~~~~~, ~~.I~. .d,~.~~~~.~~~~:...~,~.~~:~,~.i.~,~~~~......,...... 0 ~ If yes, how long has the patient experienced this paltern? 8, Does lhe patient have seizure episodes attributable to a nonrecurring transient illness. toxic ingestion. metabolic imbalance. or nonrecurring trauma? ...........................,................................................................... Q I!B. If yes. please explain _ 9. Has the patient been diagnosed as having episocies of loss of consciousness or awareness v,hiCh would interfere with the safe operation of a motor vehicle? ...............................................................!Z!I.. Q . SEiZURE DISORDER. More man one seizure or a Single seizure of s/ecrrioslly diagnosed epilepsy. PHYSICIAN INFORMATION (Plasse print or type) NAME FHVSJe AN'S SIG ' STATE LICENSE' :;<cJ~g3 e- srATE ZIP COOE PA f '10t./-3 TELEOMONE (7/7 l77rJ-f1.,~O;;"" -r -_.."......~-,..~.- ~ ~ ..'-..--;- ---=-- -_,=--.:ff ~ '-"- "-'~._- '..'. - --- ~ennsylyanla Neurological Assoc:Jat; LTD -_,. ...,- ' . CIlarlu S, Yano"k~, /1\.0. Jon L. Ylckery, /01,0, II,...... . ,l.'" l': \,>~ ;'1,": 1'1,' \,',;1 . :. ~.~ : : ,,,,,~, " .,... L; . :~.~ ro, ',.', '. . I . to: " I. t . :..;~. CHART ~OTE Albtrl W, Hock. /I\.D. ". '.1 Francit J. Jauton III, M.D. :'~ . Anna NievC5 February 18. 1999 This is a 38-year-old right-handed woman who has a ralher complex history. She had previously been followed in Ihis office by, Dr. Heck, but I've also seen her a number of times. She's moslly here 10 gel a second opinion with regard to her driving, She's been seeing Dr. Craig Jurgensen neurologically tor some reuon. since she gOt out of the Hershey Medical Cenler and had a cranIal operation, a pattlaltemporallobectamy. fur her seizures and possible AVM, I believe. on May 8,199S. ('m nOI SUl'll why she dldn't relUrnl1ere fur fullow- up. but we had major difficulties following her ill the late 80s and early !lOs. She's been declared disahled and is on Social Securily disability, but she would Ilke to work and needs to be able 10 drive, " As far as her seizures are concerned. she tell~ me that she had an event in December 1998 and dial, prior to Ihat event. she was driving or had a license. at least, with no restrictiuns. bllt it's only since the December event thaI there's a contention about reponing to PelU1DOT anti renewing her license. As far as that particullU" event, she was In a bank drive-lhrough and had an aura which, for her. was a sensation of severe shaking and humming In her head. She shut off the ignition and went on to have a full.blown seizure and was raken to the Emergency Room. Perhllps, somebO\ly at !he bank had seen her have the seizure. The lasl event befure thaI" and ~he's had absolutely nothing in.between, no auras or any other phenomena -- was In January of 1997. That was a similar event, in which she llOd a warning of shak.iness and then loud sounds in her em, or humming In her cau, She was in a vehicle at Ille time and pulled over to the side and 1051 consciousness. That's all she lemembcrs of those two events. Up until that time. over the entire year uf 1996. she said she'd had no selmrcs. so that means she's only had tWO events in recent years. by her report. Her surgery was, of cuurse. performed at Hmhey in May 1995 and. jusl after ~lC surgery. she reports Illat she conlinued to have seizures. I'm not sure. because we didn't follow her at that point. She says she finally decided to discontinue her medicin'8 which, at Ille time. were Dilanlin and Phenobarbital. Previously. many olller medicine combinations had been tried. including Dcpakotc. Tegretol ana. perhap~. uthers. ,,' '. ':1' .,.:', .. '1' . , " . . '. :'~ ' , " '.. I I , If '''1 ' "'! ; , .::~ ; . ""1 .,1 ,.7t . ','i! ".1 <<rd' f ; , ':'~f'l' .,,1 , ":1 ' , 'I I , ;1 I I I '. Harrlsview Professional Center ... :-:-- ,.~,:", "-'-y:.~:t:.~ _ '_~"4_""','" . ..~. ,_..........._ 1081.owther Street · LE!moyne. PA J 7043 . Tel~phcn;(7j'7';'774'2202 -. .,- '~'_""::":===';;:"~~':':':':"='_.:.-_.~==::.:....-.._" . --.--, .-- - ---=.:....--.-... .:-:-'. ;..,;---- ::;.:m:. ~2 ~ '. '. RE: Anna Nieves February 18, 1999 Pllg~ 2. To back up with her his!Ory. she presented with seizures. somel/mcs as many ar 30 Sl:;lUrUS a day, In ,the late ~Os and early 90s. WI: knew abo~t II lesion in the Icfllcmporal lol1~. whicll is a IIlghly cplJeplogcmc area, She was recurrcnllyadmllled 10 the hospital because of seizures OUI of cllnlrlll despite tile maxilmll use of medieatlolLl. . On lit least one admission. she was toxie on Dilantin - quite ataxic, but SIUI having seiZllrcs. Alcohol seemed 10 playa role because it seemed thaI sbe drank quite heavily.. more heavily thun Ihe would admil, according to other members of her family - so that, of course. made it difficult 10 control her seil:ures. But she appears [0 have had non-epilep[le seizures, or pseudoseizures, in grCHt abundance. This was prelly well-documented on her admission! both to Graduale Hospital in Philadelphia and the HlIfSllcy Medical Center. where she had epilepsy monitoring. Slle also had episodes that were probably true generalized mOlor convulsions, aldlough dlat wasn't well-documented untlllater on, On a number of occa5ions. .~he bit her lOngue. at times ralher bOldly. In L11\! old days, she dldn'l apparenLly have a definite aura. and it was always a question of whelllcr or not slle was drinking any alcohol. until she finally stopped. She now 11i\$ alcohol only once or twice a year, and ~he did I:ycntually claim to stop completely. As If that weren't enough. she had anotller lesion found in the MRI scan of her cervical spine, which may have also been an A VM. This was never explored surgically. 011 at lust one OI:caslon. she was ad mined with bilateral lower extremity weakness. which we though might suggest a myelopathy, bUI her physical signs were variable. anll it was felt not necessarily relevant to her cervical spine lesion, so that her situation has always prescnced quite a problem. Apparently, she's not aware of the lesion in her cervical spille, and I didn'l remember it, either. until we finally gal her old chart our of storage. For example, in December 1991. she had tl cervical MRI scan lIlat showed a somewhat serpiginous mhular SltUcture within th~ substance of the spinal cord at C6. along lbe, posterior 3spm of the C6 vertebrlll body. within the right aspect of !lIe cervical ~pinal cord, As it turns out. that's relevant or seems 10 be releyanl because. over the last seven mondlS or ~o. she says she'd developed a sort of claw hand on the right and has some numbness ill a good (lortlon of the rlgllt uppor extremity. but she docsn't have any real myelopathic symplOms al this poinl. What J'm not sure of is how she eventually llopped bt:lng s~en in this practice ;mll was eventuillly followed by Dr. Jurgensen bUI, in any case, her past medical history is otherwise fairly unremarkable. She has four chilllren, ago$ 23, 22, 18 and 16. She hrul an ovarian cyst removed laparoscopically. ,:...:,~ 1"':'1, '...':~. I,.: '\'~I ,;. . r '. ... " , '. , \,-,' .', ",! , ",' ; ':'~l " '1 i'. ,:.'.~ ",:11 I ,,' ;.;;~ " .,.,'i i; '.~~'. ; ;;:'",;;, . !'~ ;;~~I. ''l j' 'r j :,',1 ~l ,'.11 .', ,i)J, , ~r ,"', ';'/\ 1 ,A ;"1 ':1- "'.\ .', ,;J ''1 il . '~I :;:\. '. .':.'" :' ~~ ,,:I .:1 . .:1 I !'I I .i ., ~~"":";~..'" , , RE: Anna Nieves February 18. 1999 P~ge 3. She worked as n nurse's aidc and as a barmaid, She was married (or about five years 10 her husband, and Nieves is her married name. She gOt married In the ninth grade and quit school at thaI lime bul stales she had no particular difflculties academically in school. Her fallter accompanies her today, and he says she faught her twin brother how to talk and actually achieved milestones well before he did. " '~.:;~~~ Her family histOry is Ilretty Unremarkable. She has five Siblings. Her children are III good healUl. Her mother has emphysema. Her father had an operation on his cervical spine. Seeing her IOday, she's a 101 tllinner than J remember her. Her weight has fluctuated over the years. Her uptic discs were fine. Otherwise, her HEENT examlnalion was fairly unremarkable. No bruils were heard. There was decrused range of motion about the neck. She reporled that. in lateral bending 10 the left. Ihere was radiation into the right upper eXlremil)'. There were nu cranial nerye signs ar all. There was no Horner's syndrome. There was a $orl of claw hand, affecllng thu lhird, fourth and fifth digits of the righl hand, bUI she Cuu[d extend the fingers. The sensory examination found subjective decreased pinprick al about the ulnar aspect of the hand on the palmar and dorsal part of the hand. and affecting most of the radial aspect of llle forearnl, mall of Ihe arm, except an epaulet. in about the CS i1ermatome. but there was no such sensory loss on the left side. Surprisingly. r found her refIClle8 to be quite active, and lllcre was sante radiation of reflexcs. The finger flexor renClles were more active on lhe righl but, as (ur the rlghl triceps, r don't think there was aCNaUy a rellex there. only radiation into oll1er muscles, so the righllrlccps reflex may have been abselll. The lower extrcmity reflexes were IlCtivc, but the plamars were equivocal to flexor, Tbe mOlar examinarion wa~ pretty normal. There may have been some atrophy at the hypothenar eminence. but her hands were thin. so this is a difficull call, but the interossei weren'l atrophic. None of !he forearm musL'!cS seemed 10 be atrophic, either. Her gait and cerebellar examination~ were normal. IMPRESSION; The main issue is whetllcr she should be able 10 drive. According to Ute his lory I'm given now. she had only two evenl~ in recem year,~ -. mal is. December of 1998 and January of 1997 -. dIal is, spaced almost [Wu years aparl. BUlh of dl~sa were preceded by a specific KUla or prodrome, with sufficient warning to gel 10 safety while she was ariving. Curiously enough. according ro what she claims. 5he had never had her license taken away, even oyer all Ulat lime when her putative seizure disorder was very active. She seems to have an aUra or prodrome that would make ir safe for her to drive. The actual regulations may state that Ulls has to be ~ pallcrn for five YClIl'S. If so. she may not qualify under that lech'rlicalit)'. '==-;:; .....::: ::C:G:.:':~ : ":.~:; , , ~:~ t., ,.":, !,::':~ : ::",~j · .' ":':'~f ,:1 , " .'; ~ l of 'I ,4 j "j i :~ l "', l- :\ ':'l I, f I . '. , "11 ',j " <I ; ,: ..t ::":.l .,' I, . , .I. , 'I . .Il' .':"~ !..:']~ 'J, . ; ,~ ."',' " '::~:;1' J ";1 : "ilt . " : t:~ !, , . _ ':"'~f.ll . ..,....~ .' "'::r 'I:~I '., , .' "'r ..:1' 'J ,I '.~I ':' ,1 ,', ",j '1 " I I , "! '.