CLINICAL HISTORY:  41 year old male with recurrent focal status epilepticus for individual on Coumadin with seizure, fell in the bathroom, hit his head.
MEDICATIONS:  Ativan, Phenobarbital, Lacosamide, Topamax, Lisinopril, Pantoprazole, Lipitor
INTRODUCTION:  Continuous digital video EEG monitoring was performed at bedside using standard 10-20 system of electrode placement with one channel EKG.  The patient has a number of seizures, all of which he describes as remaining awake and aware throughout.  The seizures may include right hemi-sensory phenomenon or right-sided shaking.  He has some tremulousness on the left, but is alert and can use the left hand.
DESCRIPTION OF THE RECORD:  The background EEG is markedly abnormal.  The activity on the right includes excess beta and is somewhat slow and disorganized. The interictal spikes in the EEG recording are primarily high amplitude polyspike and tend to have a large field of spread in the left hemisphere including posterior temporal and central temporal. Most seizures are quite brief, some just 30 seconds in duration clinically.  They began with some activity in the central regions which may or may not be associated with suppression of the high-amplitude spikes on the right.  There is often a period of time before there is a clear clinical change.  There is theta noted from the right hemisphere during the seizures and in these seizures using different montages, there is prominent spread in the left hemisphere.
There are 8 pushbuttons, 6 well-defined electrographic seizures overall.
HR:    72 bpm
INTERVAL IMPRESSION/CLINICAL CORRELATION:  By the end of the EEG recording, the epileptiform activity was improving.
DESCRIPTION OF THE RECORD:  Random wakefulness and sleep, in wakefulness, the background EEG is somewhat slow from the right hemisphere.  The left hemisphere demonstrates arrhythmic delta activity with a high amplitude left posterior temporal spike complex.
Clinical seizures are noted reliably with the patient and nurse and there are more than 20 pushbutton events, approximately 23, all 30-60 seconds in duration.  They are characterized by focal motor activity on the right hemibody.  Electrocardiographically, there is a buzz of mixed 5 and 10 Hz activity in the left hemisphere including the central regions.   There are a handful of seizures that when seizures occur as pairs where there is a bit more of a rhythmic delta pattern that precedes it.  So, if there are 2 seizures together, the second is not as well defined as the first.  Many of the seizures occur in sleep.  Some seem to have a beta buzz early on in the seizure.
HR:    80 bpm
IMPRESSION:  This 24-hour section of EEG monitoring was remarkable for a large number of seizures.  The most disturbing seem to be have been those that occurred in sleep, but in fact, they were also seen in the early evening hours as well.  There may have been other events that looked like seizures, but were not associated with a pushbutton event and those occurred with the patient off camera, so it is difficult to know if these were clinically significant or not.  Of note, there are other sections in the
record where the patient seems to have had seizures while sleeping which did not seem to disrupt his sleep at all.
DESCRIPTION OF THE RECORD:  The interictal EEG continues to demonstrate focal slowing from the left hemisphere with left posterior temporal sharp waves.  Multiple seizures are identified in the 24 hour section, including in wakefulness and sleep.  The patient does not seem to wake up for all of them.  Stage II sleep, including the 2:00 a.m. to 3:00 a.m. section are prominent.  The nurses were aware of the seizures in sleep.  These seizures seem to be beginning with a burst of fast activity, almost some 10 to 5 Hz which is picked up very close to the midline.  The activity is really very prominent at CZ where it is a 10 Hz discharge.  This evolves to more of a theta frequency pattern and then the posterior temporal spikes continue.  Most seizures are under 30 seconds in duration.
HR:    80 bpm
INTRODUCTION:  Continuous digital video EEG monitoring was performed at bedside.  During a section of the record, the patient has approximately 40 simple partial seizures, all characterized by involuntary movements on the right.  Other seizures can occur out of sleep, but in this 24-hour section almost all the seizures seem to wake him up and are associated with right-sided shaking.
The seizures have variable patterns, but all localize to the left hemisphere.  Some seem to start with a beta buzz in the left central region, others with more higher amplitude spike and wave activity.  The interictal activity includes a pattern with excess beta and theta from the right hemisphere.  The left hemisphere demonstrates __________ delta and the epileptiform activity interictally is more of a polyspike activity in the left posterior temporal region or central parietal region.   The seizures had improved.
HR:    80 bpm
INTRODUCTION:  Continuous video EEG monitoring is performed for this individual.  He has many seizures typically characterized by right-sided shaking.
DESCRIPTION OF THE RECORD:  The majority of the seizures occur on the evening of the 26th with multiple, repetitive focal seizures.  Aside from this, he demonstrates stage 2 sleep with vertex waves, K complexes and spindles.  By the later sections of the record on the 27th, the patient has more significant sections where he is awake, doing well and then drifting off to sleep.  This piece of EEG concludes at 3:24 on the 27th.
INTRODUCTION:  Continuous video EEG recording is performed in the Long-Term Monitoring Unit using 10-20 system of electrode placement with one channel of EKG.
This section of the record captures a 5:00 p.m. to 3:00 p.m. period.  The patient has relatively few clinical seizures in the overnight recording.  There are some subclinical rhythmic beta discharges from the left hemisphere.  Left occipital temporal polyspike activity is noted, as well as some polyspike activity in sleep with a more generous field of spread throughout the left hemisphere including left central regions.
Clinical events are noted with a beta buzz and a sensory seizure at 9:28 p.m., and a more typical clinical seizure at 10:59 p.m.  This seizure is characterized by tremulousness in the right arm and leg.  The onset of this seizure is not as well defined as some of the others.  It seems to come out of some periodic slowing and sharp activity in the left hemisphere, and that activity is present for about 30 seconds before the clinical shaking stops.  Like most of the patient's seizures, it is approximately 30 seconds in duration.  Additional seizures are noted at 11:52.  Additional seizures at 12:42, 1:08 a.m., 1:16, 1:31, 1:07:46.  The 1:00 a.m. to 2:00 p.m. section is again remarkable for significant seizures, which are focal seizures, as was the patient's pattern throughout this hospitalization.  Seizures seem to stop around 2:30 in the morning.  Additional seizures are noted at 7:00 a.m. and 10:00 a.m.
IMPRESSION/CLINICAL CORRELATION:  This long-term video EEG monitoring was remarkable for many seizures with worsening of the total number of seizures over the weekend but gradual improvement toward the end of the long-term monitoring recording.  Of note, the evening hours seem to be the most prominent with very prominent seizures at that time.  This pattern is similar to previous patterns for this individual.