Neuro Seizure Follow-up

Ava was seen today at the Neurology Clinic on October 2, 2025. She is a pregnant lady with a history of epilepsy, currently at 25 weeks gestation. She was referred for evaluation of elevated liver enzymes detected during routine blood work while on Lamotrigine therapy for seizure control.

In the interim, she has been doing very well from the seizure point of view. She denies any recurrent seizure, auras, myoclonic jerk, or episode of loss of awareness. She denies any significant headaches or any new neurologic symptoms.

She has a longstanding history of generalized tonic-clonic seizures, diagnosed at age 14. She has trialed multiple antiepileptic medications in the past, with Lamotrigine being the only one well-tolerated and effective. She has been seizure-free for two years, with her last seizure occurring in August two years ago. She is currently under the care of Dr. Jordan in xxx, though she has not had regular follow-up or laboratory monitoring. Her prenatal care provider referred her due to concerns about elevated hepatic transaminases and the need for ongoing management during pregnancy.

CURRENT MEDICATIONS:

1. Lamotrigine 300 mg p.o. b.i.d.
2. Prenatal vitamins p.o. daily.
3. Folic acid p.o. daily.

NEUROLOGICAL EXAMINATION:

She is alert and oriented x3. There is no obvious abnormal movement.

CRANIAL NERVE EXAMINATION:

Pupils are equally reactive to light and normal accommodation. Visual fields and extraocular movements are full. Normal facial sensation and strength. Tongue is midline and palate symmetrical.

MOTOR EXAMINATION:

Tone, bulk, and strength are normal. Plantar responses are downgoing bilaterally. Reflexes are 2+ throughout.

SENSORY EXAM:

Normal for light touch, pinprick, and temperature.

COORDINATION:

Finger-to-nose and heel-to-shin are normal.

GAIT EXAMINATION:

Normal base, stride, height, and strength. Romberg is negative and she was able to walk on heels and toes and tandem without any difficulty.

IMPRESSION AND RECOMMENDATION:

Ava has well-controlled generalized tonic-clonic epilepsy on Lamotrigine, with recent elevation of hepatic transaminases during pregnancy. She is currently asymptomatic from both a neurological and hepatic standpoint. The etiology of the liver enzyme elevation is unclear, though Lamotrigine-induced hepatotoxicity is a consideration. She is not on any other medications apart from prenatal vitamins and folic acid.

PLAN:

Comprehensive blood work has been ordered, including liver function tests and a Lamotrigine trough level, to further evaluate the etiology of the elevated liver enzymes and monitor antiepileptic drug levels. She has been instructed to present for blood draw in a fasted state prior to her morning Lamotrigine dose, and to take her medication immediately after the sample is collected.

Dr. Jordan, her neurologist, will be notified of the current evaluation and laboratory orders. No changes to her antiepileptic regimen are recommended at this time. We will await laboratory results before considering any medication adjustments.

The importance of regular laboratory monitoring during pregnancy while on Lamotrigine was discussed. The rationale for continued Lamotrigine therapy and the risks of alternative antiepileptic medications during pregnancy were reviewed. She was advised to report any new symptoms such as jaundice, fatigue, or abdominal pain promptly.

I will contact Ava with laboratory results and further recommendations once available. I suggest continued close coordination with her prenatal care provider and neurologist to ensure optimal maternal and fetal outcomes.

Sincerely,

Dr. Riley Chen  
Neurology Clinic