CLINICAL HISTORY:  A 42-year-old gentleman with Rasmussen encephalitis and increasing right-sided weakness as well as 2 tonic-clonic seizures and simple partial seizures.
MEDICATIONS:  Vimpat Topamax, phenobarbital, IVIG, and others.
INTRODUCTION:  Digital video EEG was performed in the lab using standard 10-20 system of electrode placement with 1-channel EKG.  Hyperventilation was not possible but photic stimulation was completed.  This was an awake and drowsy record. The patient had brief seizures with R jerks just prior to initiation of EEG and had a clinical seizure with eyes closed,  looking left,  and slowed responsiveness
DESCRIPTION OF THE RECORD:  In wakefulness, the background EEG demonstrates a marked asymmetry between the 2 hemispheres.  The right hemisphere demonstrates modest background slowing with excess theta.  The left hemisphere demonstrates significant disruption of faster frequency activity.  Frequent sharp waves or spike is noted, high amplitude in the left hemisphere with variable maximum but typically maximum in the left posterior temporal or parietal region.  It sometimes appears in pairs are clusters but without frequency evolution.
SEIZURE : 3:32 PM 73 seconds characterized by 5 seconds of R sided, temporal maxima theta after which EEG obscured by muscle. Little post ictal slowing, beyond the abnormal background bilaterally
HEART RATE:  72 BPM.
IMPRESSIONS:  This is an abnormal EEG due to:
Seizure from the right temporal region
Left posterior temporal epileptiform discharge with variable maximum.
Marked slowing on the left.
Mild background slowing and disorganization on the right.
CLINICAL CORRELATION:  The focal features on the left are anticipated findings following resection for refractory epilepsy in the left hemisphere.  The seizure recorded in the EEG differs from the patient’s usual seizure and emanates from the right