CLINICAL HISTORY: This is a 41-year-old male with a history of seizures secondary to astrocytoma with a resection x 2, admitted for increasing seizures.
MEDICATIONS: Dilantin, Phenobarbital, and Baclofen.
INTRODUCTION: Digital video EEG is performed at the bedside in the long-term monitoring unit using standard 10-20 system of electrode placement with one channel of EKG.
DESCRIPTION OF THE RECORD: The background EEG is low voltage.  There is nearly continuous T4 spike wave activity. Soon after the recording begins, at 17:13, the patient has his first seizure.  It starts with his right hand rubbing his nose and staying there for about 10 to 15 seconds.  He then began to shake in his left hand, going up to his shoulder, then involving the right hand and both legs.  At that time, his face is turned to the right. Subsequently, his right hand stops shaking and only his left arm and right leg are still shaking.  At that time, his face turns to the left with both eyes deviated to the left. On the video, the rhythm of the left arm shaking is different from that of the right leg shaking.  It seems that the right leg shakes faster than the left arm for about 10 seconds and then the shaking is synchronized (left arm and right leg).  This spell lasts for about three minutes and the patient stopped seizing without a postictal phase and was moving spontaneously his left arm and could talk.  These types of spells occurred quite frequently, anywhere from several minutes to 30 minutes. During the spell, he can hold some objects in his right hand without dropping them.  After the seizure, the patient can put the objects by the bedside himself.  On the tracing, we counted a total number of spells to be 76. More than 40 occurred prior to midnight and about 30 after midnight.  Some high amplitude spike waves emanating from the C4 leads were seen in about half of the patient’s spells.  All of the patient’s spells had a similar course, lasting about 2 to 3 minutes. They started at the left arm, going to the right arm and then generalized tonic-clonic jerking. There was right shaking first and then asymmetric shaking of the left arm and right leg.  From the video, the patient seems to be unresponsive during his spells, but he responds normally immediately after the spells stop.
HR:  84 BPM.
IMPRESSION: Abnormal EEG due to:
1.  More than 100 seizures
Frequent epileptiform discharges, which were well correlated with clinical seizures.
Nearly continuous T4 spike waves.
Low voltage recording.
CLINICAL CORRELATION: This video EEG demonstrates frequent epileptiform discharges and is well correlated with clinical seizure activity.  The nearly continuous right temporal spike waves may be suggestive of a local pathology for epilepsy.