CLINICAL HISTORY: This is a 33-year-old woman admitted with a history of seizure disorder, drug abuse, with multiple seizures and loaded with Dilantin in the ER.
MEDICATIONS: Dilantin, Topamax, Remeron, and Reglan.
INTRODUCTION: Digital video EEG is performed in the long-term EEG monitoring unit using standard 10-20 system of electrode placement with one channel of EKG. Hyperventilation and photic stimulation were performed.  This is an awake through random sleep record.
DESCRIPTION OF THE RECORD: In wakefulness, the background EEG is symmetric with a lot of muscle activity.  There is a 9 Hz, 30 V posterior dominant rhythm and a small amount of frontocentral beta activity.  Rare left temporal sharp activity is seen, especially during light sleep.  However, it is less evident prior to the long-term EEG monitoring.  Sleep is evidenced by slow rolling eye movements, vertex waves, spindles, and K complexes.  Stage III sleep was achieved, but not sustained.
EVENTS: One event was recorded by the patient pushing the button.  At 19:08, the patient was awake and lying still on the bed.  At 19:13, the patient began to look for the button and pushed it.  At that time, left temporal sharp activity can be recognized.  The patient was quietly lying on the bed without seizures.  At 19:19, the left temporal sharp activity increased in amplitude for about 20 seconds and then subsided.  She was still quiet, lying on the bed.  At 19:20, she began to rock her body, most likely using her abdomen and back muscles.  This lasted for about 30 seconds and stopped without a postictal EEG change. The EEG showed artifact but no spike wave epileptiform activity was recorded during this event.
HR:  96 BPM.
IMPRESSION: Abnormal EEG due to:
Occasional left temporal sharp activity.

Long-Term Monitoring, 11/18/03 at 06:22 to 13:05
CLINICAL HISTORY: This is a 33-year-old woman admitted with a history of seizure disorder, drug abuse, with multiple seizures and was loaded with Dilantin in the ER.  Patient had an episode of a shorter seizure yesterday.
MEDICATIONS: Dilantin, Topamax, Remeron, and Reglan.
INTRODUCTION: Digital video EEG is performed in the long-term EEG monitoring unit using standard 10-20 system of electrode placement with one channel of EKG.
DESCRIPTION OF THE RECORD: In maximum wakefulness, the background EEG is symmetric and low voltage.  There is a 9 Hz, 30 V posterior dominant rhythm and a small amount of low voltage, frontocentral beta activity.  Rare left temporal sharp activity is seen during light sleep.  Generous amounts of muscle artifact are picked up during movement.  The patient moved out of camera range many times from 09:27 and returning ten minutes later.  A few minutes later, she again left camera range and was off camera for about 30 minutes.  The longest duration off camera was from 12:05 to 12:59.  At this time, the patient took off the box and disconnected all the electrodes herself.  Audio is also unclear, because the patient is off camera range and the record ended at 13:05.  During this period, no events were recorded and no push buttons were noted.
HR:  84 BPM, while sleeping.  HR was not recorded while patient was out of bed.
IMPRESSION: Abnormal EEG due to:
Rare left temporal sharp activity.
CLINICAL CORRELATION: The focal features of left temporal sharp activity may be responsible for the partial mechanism of epilepsy in this patient.  One episode was recorded during this two-day long-term EEG monitoring, but the EEG recording and suggested artifact as well as the video camera is consistent with a shorter seizure.  Also, the lack of EEG postictal phase change is consistent with a non-epileptic seizure.