CLINICAL HISTORY: 31 year old woman with cerebral palsy, refractory epilepsy, seizure-free for the past 4 years until she had a tonic-Donnie seizure 1 month ago followed by multiple seizures. Past history of stroke and epilepsy.
MEDICATIONS: Depakote
INTRODUCTION: Digital video EEG was performed in lab using standard 10-20 system of electrode placement with 1. channel of EKG. The patient is awake. Hyperventilation and photic stimulation are performed.
DESCRIPTION OF THE RECORD: In wakefulness, the background EEG Is markedly abnormal with
primarily a theta frequency background. There are bursts of generalized spike and wave and slow spike and wave activity. 'The bursts are typically 3 to 5 seconds in duration. There is also some more restricted frontally predominant spike and wave activity, a little more at the midline. Focal epileptiform activity is also observed including CZ, C3, and left anterior temporal. What appears to be generalized paroxysmal fast activity of approximately alpha frequency is noted. The patient drifts off to sleep with vertex waves and in sleep there seems to be ongoing slow spike and wave activity. In the transition to sleep, felt parietal sharp waves are noted. Photic stimulation does no activate the record.
HR: 60 to 70 bpm
IMPRESSION: Abnormal EEG due to:
1, Abnormal background.
2, Slow spike and wave activity with variable maximum, sometimes a bit more prominent in the left parietal region.
3. Focal epileptiform activity.
4. Background slowing and disorganization.
CLINICAL CORRELATION: These findings are relatively characteristic in individuals with a Lennox-Gastaut type syndrome in terms of epilepsy. They are associated with cognitive impairment and typically more refractory epilepsy with multiple seizure types. These findings observed today were not associated with clinical changes but if there are additional questions, additional EEG recording may be obtained. Correlation with the patient's imaging and anti epileptic drug levels is suggested.