CLINICAL HISTORY: 91 year old with past medical history of dementia, hypertension,
and generalized compulsive seizures.
MEDICATIONS: Lisinopril. ASA, Metformin, Keppra.
REASON FOR STUDY: Rule out
INTRODUCTION: Digital video EEG was at bedside using standard 10-20
system of electrode placement system with additional anterior temporal electrodes and
EKG electrodes. Patient was obtunded during recording. No activating procedures
were performed.
DESCRIPTION OF THE RECORD: The record opens to a diffusely slow asymmetric
background. The left hemisphere is composed of theta frequencies with intermixed
beta frequencies mainly seen in the frontal regions but some of them can be seen more
posteriorly. The amplitude of these on the left hemisphere is 20 to 50
microvolts. The right hemisphere is of delta frequencies with low amplitude
about 20 to 30 microvolts and seen No sleep architecture or normal
posterior dominant rhythm is seen. No procedures were performed. While
the patient is stimulated, there is mild change in the frequencies of the recording.
TECHNICAL DIFFICULTIES: None.
ABNORMAL DISCHARGES:
1. Right hemispheric delta slowing and
2. Generalized slow waves.
SEIZURES: There are 6 seizures seen. T majority due not have a clear onset, but
appear to be emanating from the right hemisphere. Two of them appear to develop with
mid temporal (T4) beta that evolves in frequency and amplitude over the right
hemisphere. As it continues to evolve, the left hemisphere picks up muscle artifact
which continues .to evolve and╖ contaminate-\he whole EEG. After a minute Of so, the
muscle artifact decreases and an evolving discharge over the right hemisphere maximal
in the frontotemporal region can be seen which suddenly stops. After the seizure ends,
there is a well-defined right hemispheric slowing that appears to be post ictal. The
seizures last an average duration about 2 minutes.