DATES OF STUDY:  February 23-24, 2012.
CLINICAL HISTORY:  Rasmussen encephalitis with increase in seizures.
MEDICATIONS:  Vimpat, Topamax, phenobarbital, IVIG, others.
INTRODUCTION:  Continuous video EEG monitoring is performed in the unit using standard 10-20 system of electrode placement with one channel of EKG.  This is an awake and asleep record.
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.
Heart rate 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.