CLINICAL HISTORY: 26 year old right handed male with epilepsy since the age of 2, last seizure a week ago. The patient reports that he has never had well-controlled epilepsy.
MEDICATIONS: Lamictal, Zonisamide, Carbamazepine, Dilantin, Phenytoin, Tegretol
INTRODUCTION: Digital video EEG was performed in lab using standard 10-20 system of electrode placement with 1 channel EKG. Hyperventilation and photic stimulation were completed.
DESCRIPTION OF THE RECORD: In wakefulness, there is a 9Hz alpha rhythm identified bilaterally. There is a small amount of low voltage, frontocentral beta activity. There is a subtle asymmetry in terms of the field of faster frequency activity with disruption of faster frequency activity noted quite subtly in the right frontotemporal region. Features of drowsiness include an increase in beta, followed by vertex waves. Post-suppressant bilaterally, but are a little higher amplitude on the left compared to the right. Photic stimulation does not significantly activate the record. Hyperventilation does not significantly activate the record. Photic stimulation is performed while the patient is drifting in and out of sleep, and does not significantly activate the record. At the close of the record after photic as the patient is starting to arouse in and out sleep, again very subtle focal features are noted in the right frontotemporal region.
HR: 60 bpm
IMPRESSION: Abnormal EEG due to:
1. Subtle asymmetry with disruption of faster frequency activity in the right anterior quadrant.
CLINICAL CORRELATION: In comparison to previous long-term EEG monitoring recorded for this patient in 2008, there is very little in the way of focal slowing and no right temporal sharp waves were noted. Previous clinical seizures were quite challenging for this individual, but seem to have localized to the right hemisphere.