CLINICAL HISTORY: 39 year old right handed male with recurrent complex partial seizures.

MEDICATIONS: Dilantin, Topamax, Phenytoin, Clonazepam, Protonix, Lorazepam, Lipitor, Lisinopril, Prednisone

INTRODUCTION: Digital video EEG monitoring was performed at bedside using 10-20 system of electrodes with 1 channel of EKG. The patient reports some auras, but no major seizures.

DESCRIPTION OF THE RECORD: In wakefulness, the background EEG includes a somewhat slow pattern from both hemispheres with primarily theta on the right. Arrhythmic delta is seen from the left. High amplitude spike and slow wave complexes are noted. There are practice push buttons recorded without epileptiform activity. There appears to be an aura at 20:50 and 21:10. These two sections of the record demonstrate relatively frequent left parietal sharp waves, some that are a little more anterior. There is a bit of a buildup with these, however, identical sections of the record are seen with similar buildup without clinical correlate. The sleep record includes high amplitude spike and slow wave and polyspike activity, particularly left posterior temporal and parietal. Other features of sleep include beta spindles.

HR: 84 bpm

LONG TERM MONITORING 09/29/2010 to 09/30/2010

INTRODUCTION: Digital video EEG is performed in the long term monitoring unit. During this section, the patient has an episode of prolonged focal jerking of the right hemibody. Hyperventilation and photic stimulation are performed.

DESCRIPTION OF THE RECORD: Time Samples: The background EEG remains abnormal with a theta frequency pattern. Focal slowing is observed from the left hemisphere with superimposed high amplitude left parietal sharp waves. The patient's clinical event is remarkable for right unilateral jerking.


The event can be identified on the EEG. There is frequent high amplitude spiking on the left and sometimes this seems to be evolving. Looking at the video, there is a problem with the video and the video camera itself is also moving around.

There is a beta buzz noted from the right hemisphere during this session and then at 12:23:48 on the right, when the event becomes much more clinically symptomatic. The beta buzz is seen again at 12:24:15 and seems to be a unique finding prior to what is the most significant clinical seizure with jerking at 12:24:57. The jerking is associated with artifact in the EEG. After the prolonged event, the patient reports that for the first time in many days he has

IMPRESSION: EEG monitoring this LTM session was remarkable for:
1. High amplitude spike and slow wave complexes in the left hemisphere, primarily left posterior temporal and parietal.
2. Rhythmic delta activity, primarily from the left hemisphere.
3. Background slowing on the right.
4. A beta burst of activity was observed at 01:0820 of unclear clinical significance.
5. That was a generalized burst and may represent a sleep form.

CLINICAL CORRELATION: This EEG supports a highly irritative process. Of note, there are sections with rhythmic theta delta in the left hemisphere, particularly central temporal regions without clear clinical correlate and the patient's auras are difficult to differentiate from his background. He has occasional isolated myoclonic jerks, though it was difficult to determine if these are associated with high amplitude left parietal spiking.