CLINICAL HISTORY:  27 year old gentleman with mitochondrial disease, MELAS, refractory epilepsy, cardiomyopathy, admitted with recurrent salaam seizures characterized by flexion of the left arm in an almost purposeful manner, elevation of the right arm and stiffening.  No new other medical issues.  This is the patient's first status epilepticus in 2 years.
MEDICATIONS:  Vimpat, Dilantin, Ativan, Klonopin, Topamax
INTRODUCTION:  Digital video EEG was performed at bedside using standard 10-20 system of electrode placement with 1 channel EKG.  The patient was obtunded with frequent seizures.  He did not appear to be interactive to outside stimuli.
DESCRIPTION OF THE RECORD:  The background EEG is markedly slow, featureless low voltage with delta and smaller amounts of beta. Frequent seizures were recorded.  Electrographic discharges were typically 5-7 seconds in duration and included mixed frequency, generalized paroxysmal fast activity which was frontally predominant.  Typically, it was not until the third second of the electrographic discharge that the patient had the behavioral correlate with flexion of the left arm, stiffening of the right and tonic posturing.   Based on these results, the patient was placed on long term video EEG monitoring and pharmacotherapy was initiated.  This EEG is diagnostic of a generalized form of status epilepticus.
HR:   N/A
IMPRESSION:  Abnormal EEG due to:
Markedly abnormal background.
Bursts of paroxysmal fast activity with associated clinical seizures.
CLINICAL CORRELATION:  The bursts of paroxysmal fast activity described in this EEG differs from previous EEGs.  This may represent a new seizure pattern for this individual or maturation of a pre-existing or interictal pattern.  He previously had frontal spike and wave activity.