Document G6ap7eaxReeQvkd7L89MNe06x

4. Nussbaum K, Schneidmuhl AM, and Shaffer |W: Psychiatric disability rating in transition. Compr Psychiat 10:327-333, 1969. APPENDIX Composite Case Report from Treating Physician This 23-year-old woman has been under my care intermittently at the . . . Hospital in . .. since December 1974 for temporal lobe epilepsy which has been extremely difficult to control. Neurological consultation by Dr... . on 1-20-75 reported no posi tive neurological findings on physical examination. The EEC was grossly abnormal, showing bilateral temporal spikes which were particularly prominent in the sleep record. Currently, she is having four to five brief episodes a week of loss of contact which last less than 1 minute during which she stares but does not fall. Autom atisms and episodes of antisocial behavior occur with equal frequency. In addition, approximately tvyo to three times a month there are episodes of total loss of consciousness, falling to the ground, usually with incontinence of urine and, upon occasion, self-injury. Occasionally, an olfactory aura was reported. Her present medication is Dilantin, 400 mg. a day, Celontin, 900 mg. a day, and phenobarbital, 96 mg. a day. On this regimen, seizures remain basically unchanged. Several attempts have been made to increase the medication but these resulted in lethargy and ataxia, serum Dilantin and phenobarbital levels were found to be ex cessively high, and a reduction in dosage became necessary. Other than this she is perfectly capable of performing daily ac tivities but as you can imagine, it is difficult to maintain stea ' ployment with seizures occurring this frequently and sudd' suitable employment could be found, which apparently^ case it cannot, she could be employed. As she is, I thT probably can be considered severely impaired. There are considerable emotional components involved j difficulties. This is not to say that the seizures are emotion only that when she is upset or disturbed the seizures b-' more difficult to control. It is expected that she would p| come under better control at some future time, and curretf are again adjusting her medications in hopes that this will'fj complished. However, we cannot say with any certainty w this will be successful. Instructions for use of Form Sections I, II, and III are designed for a review of syrript' signs, and laboratory findings. A rating of "present" indicated the item in question is mentioned in the record. An item ri*recorded is considered "absent." Should the presence of the: be suspected, and verification be essential to determining sevig rating should be deferred until the necessary information has ti obtained. Section VI has been added to assure reexamination aftr stated interval in those instances where it seems possible that* stantial changes in condition are expected. It will not be requ in cases where the impairment is likely to remain unchajij Intimidation by Officialese It is little wonder that human beings have so much trouble saying what they feel, when they are told that there is a specialized vocabulary for saying what they think. The language of simplicity and spontaneity is forced to retreat behind the barricades of an official prose developed by a few ex perts who believe that jargon is the most precise means of communication. The results would be comic if they were not so poisonous; unfortunately, there is an attitude toward the use of language that is impervious to human need and drives some people back into silence when they realize the folly of risking human words on insensitive ears. -- From "The Human Use of language" by Lawrence L. langer. in Chronicfe of Higher Education. January. 1977. 618 Impairment in Seizure Disbrders/Nussbaum and 0'Corin