CLINICAL HISTORY:  61 year old right handed woman with refractory seizures with a history of a left MCA clip and shunt in 2005, hypertension, and diabetes.
MEDICATIONS:  Prednisone, Lisinopril, HCTZ, Depakote, Heparin, Neurontin, Levetiracetam.
REASON FOR STUDY:  Seizures.
INTRODUCTION:  Digital video routine EEG was performed using the standard 10-20 electrode placement system with additional anterior temporal and single-lead EKG electrodes.  The patient was recorded during wakefulness and sleep.  Activating procedures were performed including only photic stimulation.
TECHNICAL DIFFICULTIES:  None.
DESCRIPTION OF THE RECORD:  The record opens to a well-defined posterior dominant rhythm that reaches 8.5 to 9 Hz, which is reactive to eye opening.  There is a normal amount of frontocentral beta.  Activating procedures including photic stimulation produce no abnormal discharges.  The patient is recorded during wakefulness and stage I and stage II sleep.
ABNORMAL DISCHARGES:
Focal slow waves seen at F3, continuously, at a frequency of 2 to 4 Hz, with intermittent increasing faster frequencies and beta seen in that region, as well as higher amplitude consistent with a breach rhythm.
Focal slow waves seen independently at F7/T3, occasionally, at 2 to 4 Hz with an amplitude of 20 to 60 microvolts.  At times, in between the breach there are some very sharply contoured transients.
SEIZURES:   None
IMPRESSION:  Abnormal EEG due to:
Left frontal slowing and breach.
Left anterior temporal slowing.
CLINICAL CORRELATION:  This EEG reveals evidence of focal cerebral dysfunction in the left frontal region which is consistent with the known surgery.  In addition, there is
some evidence of left anterior temporal slowing which is nonspecific with regard to etiology.  No seizures or epileptiform activity was clearly seen.