CLINICAL HISTORY:  38 year old right handed female with seizures since she was 3 years of age, now with increased seizure frequency, here for presurgical evaluation.
MEDICATIONS:  Lorazepam, Keppra, Oxcarbazepine, Lyrica, Zonisamide.
REASON FOR STUDY:  Seizures
INTRODUCTION: Digital video EEG was performed in lab using standard 10-20 electrode placement system with additional anterior temporal and single-lead EKG electrodes.  The patient was recorded in wakefulness and sleep.  Activating procedures were performed including hyperventilation and photic stimulation.
TECHNICAL DIFFICULTIES:  None.
DESCRIPTION OF THE RECORD:  The record opens to a well-defined posterior dominant rhythm of 9 to 10 Hz, which is seen on both sides and is reactive to eye opening.  There is a normal amount of frontocentral beta.  The patient is recorded in wakefulness and stage I and stage II sleep.  Activating procedure produce no abnormal discharges.
ABNORMAL DISCHARGES:
Focal sharp waves seen at F7/T3, very frequently, and rarely at F8/T4.
Focal slow waves seen at F7/T3 at 2 to 4 Hz with an amplitude of 20 to 70 microvolts.  At times they become rhythmic and are consistent with temporal intermittent rhythmic delta activity (TIRDA).  Additionally, there are some focal slow waves infrequently seen at F8/T4 at 2 to 4 Hz at an amplitude of 20 to 70 microvolts.
IMPRESSION:  Abnormal EEG due to:
1.  Frequent left anterior temporal sharp waves and slow waves with rare right anterior temporal sharp waves and slow waves.
CLINICAL CORRELATION:  This EEG is consistent with a diagnosis of localization related epilepsy with seizures likely arising from either anterior temporal lobe.  No seizures were seen during this recording.