CLINICAL 38 year old right handed gentleman with encephalopathy admitted with refractory seizures, worsening aphagia, right foot numbness and worsening right hemiparesis, occasional myoclonus.
MEDICATIONS: Topiramate, Steroids, Dilantin, Klonopin, Lisinopril, Prednisone, Protonix, Coumadin, Lipitor
INTRODUCTION: Digital video EEG was performed in lab using standard 10-20 system of electrode placement with 1 channel of EKG. Hyperventilation and photic simulation are performed.
DESCRIPTION OF THE RECORD: The background EEG demonstrates a significantly slow pattern on the right with lower voltage, mixed theta delta pattern. The left hemisphere demonstrates arrhythmic delta activity with high amplitude epileptiform activity with complex field of spread including posterior temporal. Some of the epileptiform activity is at the vertex. Much of it appears at PZ or T5. There is an electropositivity at CZ that marches through in the averaged reference with an electronegativity P3T5. In addition, there are other wave forms that are actually electronegative and maximum at PZCA compatible with very complex epileptiform activity. The highest amplitude activity is a left posterior temporal spike focus. The epileptiform activity occurs. as frequent but relatively isolated discharges which do not evolve, although the activity at CZPZ does seem to have more of a rhythmic pattern. Photic stimulation does not appreciably change the EEG.
HR: 90 bpm
IMPRESSION: Abnormal EEG due to:
1. Complex epileptiform activity in the left hemisphere with an unusual field of spread.
2. Epileptiform activity at CZPZ.
3. Arrhythmic delta on the left.
4. More rhythmic lower voltage slowing on the right.  CLINICAL CORRELATION: This EEG supports a diffuse bihemispheric disturbance of cerebral function but more importantly a focal mechanism for seizures. Although there was prominent epileptiform activity, no sustained or evolving ictal discharges were observed.