CLINICAL HISTORY: 50 year old right handed woman status post left MCA aneurysm repaired in 2003 with annual exacerbation of complex partial seizures and low serum levels.
MEDICATIONS: Depakote, Keppra,
INTRODUCTION: Digital video EEG was performed at bedside using standard 10-20 system of electrode placement with 1 channel of EKG. This is a prolonged study for a patient who appeared to have had a subclinical seizure. She was confused during the EEG and somewhat lethargic.
DESCRIPTION OF THE RECORD: The background EEG is markedly abnormal. The background from the right hemisphere is slow and disorganized. The left hemisphere includes a high amplitude breech rhythm with a left frontal sharp and slow complex with arrhythmic delta activity.
At 9:15 the patient is relatively inattentive and the technologist wraps the head. At some point essentially continuous spiking is noted in the left frontal region.
A seizure is identified at 9:19 characterized by evolution of epileptiform activity in the left frontal region, which is high amplitude with a generous field of spread. The seizure duration is from 19:13:30 to 19:19:59 suggesting that this is a relatively brief seizure. The technologist transitions from this to additional recording at 09:21. After the first event with impaired responsiveness, high amplitude left frontal spiking is noted with a breech rhythm in the abnormal background. The patient's mental status actually improves somewhat. She moves about, although she is confused. The activity remains quite slow in both hemispheres.
There was another brief build up again at 9:40. Artifacts are picked up at 9:35, but again there is prominent spiking in the background with very prominent epileptiform activity.
A third electrographic seizure occurs at 9:58:57. The patient is relatively somnolent. Stimulation of the patient does not occur during this testing, but the seizure stops by itself and as it does the patient moves about.
By the morning of the 7th, she is more consistently awake, out of bed with more rhythmic theta frequency in the background although the patterns in both hemispheres are slow.
Throughout the record, there are intermittent bursts of rhythmic delta which do not have a clear clinical correlate.
Seizure: The patient is in bed and she has just off the monitor. Her head is off the monitor. She appears to be sleepy. At  13:35 she was awake and the seizure is 12 minutes later. At 13:44 with the patient with someone at the bedside, in fact a physician examining her, the left frontal delta is prominent as are some sharp waves but she is interactive somewhat with the individual examining her. As the student leaves, the patient drifts over to the right.
The electrographic seizure is at 13:47:13 and the patient is not really moving during the event but starts to reposition afterwards.
This event is characterized by rhythmic, faster frequency activity in the left frontal and temporal region with also a beta accentuation.
After the seizure was over, the patient looks about.
HR: 78 bpm
IMPRESSION: Abnormal continuous EEG monitoring due to:
1. Well-defined electrographic seizures noted but with only one seizure In the last 24 hours of recording.
2. Left frontotemporal focus.
3. Focal slowing from the left.
4. Generalized background slowing quite marked in the beginning of the record but better at the close of the record.
CLINICAL CORRELATION: This EEG is diagnostic of a localization-related
mechanism for epilepsy. Additional recording may be appropriate if this patient's mental status does not improve.
HR: 78 bpm
IMPRESSION: This section of EEG, which includes a routine 20 minute EEG, followed by 50 minutes of recording, includes multiple, brief complex partial seizures. Although the patient's mental status is abnormal, the clinical correlate for this patient's seizures includes impaired responsiveness.
INTRODUCTION: Continuous digital video EEG is performed in the LTM unit using the standard 10-20 system of electrode placement. The patient has a pattern of improving mental status over the course of the day. She, unfortunately, eliminated her EEG electrodes during the overnight recording.
DESCRIPTION OF THE RECORD: Despite the improved clinical appearance of the patient, there are electrographic seizures identified. These occur when the patient is in bed sleeping, without clinical correlate. They are associated with runs and bursts of activity.
Time: 19:0838 - Approximately 1 minute in duration.
Time: 19:5442 - Another seizure, maximum, in the left frontal and temporal region with a generous field of spread. Of note, the majority of the electrographic seizures are at approximately 8 p.m. and shortly thereafter the patient starts to remove the EEG electrodes. Of note, however, the patient did receive Versed in the morning and although there were frequent high amplitude left frontocentral sharp waves, the
recurrence of seizures was primarily many hours afterwards.
INTERVAL IMPRESSION/CLINICAL CORRELATION: Electrographic seizures for this individual were well-defined with characteristic frequency evolution despite the prominent interictal sharp waves from the left frontocentral region and frontotemporal region.
INTRODUCTION: Continuous digital video EEG was performed at bedside using standard 10-20 system of electrode placement with 1 channel of EKG. At least one electrographic seizure is noted but no clinical seizures are observed. The patient's mental status gradually improves over the course of the record with the patient able to eat and get out of bed as well as participate in care.
DESCRIPTION OF THE RECORD: The initial sections in this epoch include a markedly slow pattern with slower delta and rhythmic theta frequency from both hemispheres and high amplitude sharp and slow or spike and slow wave complexes, many of which are frontotemporal but some of which are T1. The patient is certainly much sleepier on the 6th compared to the 7th.
By the morning of the 7th, she is more consistently awake, out of bed with more rhythmic theta frequency in the background although the patterns in both hemispheres are slow.
Throughout the record, there are intermittent bursts of rhythmic delta which do not have a clear clinical correlate.
Seizure: The patient is in bed and she has just off the monitor. Her head is off the monitor. She appears to be sleepy. At  13:35 she was awake and the seizure is 12 minutes later. At 13:44 with the patient with someone at the bedside, in fact a physician examining her, the left frontal delta is prominent as are some sharp waves but she is interactive somewhat with the individual examining her. As the student leaves, the patient drifts over to the right.
The electrographic seizure is at 13:47:13 and the patient is not really moving during the event but starts to reposition afterwards.
This event is characterized by rhythmic, faster frequency activity in the left frontal and temporal region with also a beta accentuation.
After the seizure was over, the patient looks about.
HR: 78 bpm
IMPRESSION: Abnormal continuous EEG monitoring due to:
1. Well-defined electrographic seizures noted but with only one seizure In the last 24 hours of recording.
2. Left frontotemporal focus.
3. Focal slowing from the left.
4. Generalized background slowing quite marked in the beginning of the record but better at the close of the record.
CLINICAL CORRELATION: This EEG is diagnostic of a localization-related mechanism for epilepsy. Additional recording may be appropriate if this patient's mental status does not improve.