CLINICAL HISTORY:  41 year old right handed male with Rasmussen’s encephalitis with increasing seizures.
MEDICATIONS:  Topiramate, Lacosamide, Phenobarbital, Klonopin, Lipitor, Pantoprazole, Lisinopril
INTRODUCTION:  Digital video EEG was performed in lab using standard 10-20 system of electrode placement with channel of EKG.  Photic stimulation was performed.
DESCRIPTION OF THE RECORD:  The background EEG is markedly abnormal.  As the record begins, the activity includes a prominent interhemispheric asymmetry.  It is medium amplitude, but slow, primarily theta on the right with some occasional posterior delta.  From there left there is clearly a breach with a high amplitude spike and slow-wave complex at T3 and T5.  It is also picked up at C3/P3.
The first seizure occurs within 1 minute with a burst of 14 Hz activity emanating from the left frontal region with frequency evolution.  This is over 4 minutes and 35 seconds into the EEG.  Additional seizure occurs at 4 minutes and 40 seconds, and another similar seizure with the fast activity from the left frontal region at 3 Hz photic stimulation.  In that seizure, focal spiking is noted at T5.  Photic stimulation does not otherwise activate the record.
HR:    90 bpm
IMPRESSION:  Abnormal EEG due to:
Focal slowing to the left hemisphere with disruption of faster frequency activity.
Modest slowing from the right.
Epileptiform activity in the left hemisphere which may be centrotemporal, left hemispheric, or left posterior temple.
Unusual seizure pattern which seems to start with 14 Hz activity from the frontal and frontotemporal regions on the left but ends with a posterior temporal spike.
CLINICAL CORRELATION:  This is not substantially different from previous EEG monitoring sessions for this individual, although these seizures are exquisitely focal.  Additional EEG monitoring will be initiated as pharmacotherapy is implemented.