CLINICAL HISTORY: 63 year old woman with an episode a month ago of loss of consciousness with confusion, has occurred 2 times per week, has significant hypertension, COPD, aneurysm, asthma, infarction, and history of seizures.
MEDICATIONS:  Neurontin, Lopressor, Norvasc, Remeron, also supposed to be taking Keppra, unfortunately in the last note from the doctor, appears that she was noncompliant.
REASON FOR STUDY:  History of seizures.
INTRODUCTION:  Digital video routine EEG was performed using the standard 10-20 electrode placement system with anterior temporal and single-lead EKG electrode.  The patient was recorded while awake and drowsy.  Activating procedures were not performed.
TECHNICAL DIFFICULTIES:  None.
DESCRIPTION OF THE RECORD:  The record opens to a well-defined posterior dominant rhythm that reaches at 10-11 Hz seen mainly over the left hemisphere and somewhat attenuated and interrupted over the left hemisphere.  There is a normal amount of frontocentral beta.  No activating procedures were performed.  The patient was recorded only in wakefulness and drowsiness.
ABNORMAL DISCHARGES:
Focal sharp waves seen intermittently at T6, sometimes at C4/P4.
Focal slow waves seen continuously over the right hemisphere, maximum over the anterior temporal region at F8/T4, but sometimes more at C4/F4.
Rhythmic run of C4 sharp wave with some evolution.
SEIZURES:  There were 4 seizures that began at electrode T6 with evolving low amplitude beta frequency that decreases in frequency, but increases in amplitude and evolves to sharp waves and spreads to the right occipital region and right parietal quadrant, then stops suddenly.  The seizures last anywhere from 1 minute to 2 minutes.  During the events, there appears to be no clinical correlate and during one of them, the technician asks the patient to count backwards while it is occurring and the patient is able to perform the command with no difficulty.
IMPRESSION:  Abnormal EEG due to:
4 electrographic right posterotemporal seizures.
Right hemispheric slowing maximally in the anterior temporal region.
CLINICAL CORRELATION:  This EEG is consistent with the diagnosis of localization-related epilepsy with seizures arising from the right posterotemporal and central region.  In addition, there is evidence of focal structural cerebral dysfunction in the right hemisphere, maximal in the anterior temporal region, which is consistent with the known stroke.  The findings in the EEG were communicated to her primary care doctor and multiple calls were made to the patient to make her aware of her diagnosis.  However, no answer was obtained.