CLINICAL HISTORY:  27 year old man known to Neuro with a  previous history of mitochondrial disease, MELAS, refractory epilepsy, cardiomyopathy, recurrent seizures characterized by flexion of the arm, elevation of the right arm and stiffening.  Also, a history of status epilepticus.
MEDICATIONS:  Ativan, Topamax, Clonazepam, Lisinopril, Vimpat, Dilantin, Norvasc, Metoprolol
REASON FOR EGG:  Seizures.
INTRODUCTION:  Digital video routine EEG was performed using the standard 10-20 electrode placement with the addition of anterior temporal and single lead EKG electrode.  The patient was recorded while asleep mainly.  Activating procedures were not performed.
TECHNICAL DIFFICULTIES:  None.
DESCRIPTION OF THE RECORD:  The record opens with the patient in sleep, mainly in Stage II with no normal posterior dominant rhythm or normal frontocentral beta seen.  In between the recording the patient develops paroxysm bursts of fast activity which appears to be diffusely seen and mixed with myogenic artifact. It is difficult to piece out the electric serial activity from the myogenic artifact, but clearly occurs paroxysmally in bursts lasting up to 20 to 21 seconds.  During this event there is no clear changes that can be seen on the EEG and in the latter halves of the bursts there appears to be some rhythmic theta-like activity.  Frontal theta predominant consistent with some frontal slowing.  Otherwise, the patient is recorded mainly in sleep.
ABNORMAL DISCHARGES:
Bursts of polyspike generalized discharges lasting for a second.
Generalized slowing, absence of normal EEG architecture even during wakefulness.
SEIZURES:
The above described episodes of generalized polyspike and fast followed intermixed with myogenic artifact and followed by some frontal theta consistent with generalized seizures.  However, clinically there are no clear behavioral changes seen on the video.
IMPRESSION:  Abnormal EEG due to:
Generalized seizures.
Polyspike discharges.
CLINICAL CORRELATION:  This EEG is consistent with the diagnosis of generalized epilepsy with multiple seizures seen during the recording.  No normal awake activity was seen, but mainly the patient was recorded with intermittent sleep.  It is suggested to have continued recording of this individual as the seizures are treated]