CLINICAL HISTORY:  Adult male status post gunshot wound to chest and back.  At 4:00 a.m. today the patient had generalized tonic-clonic seizures requiring 7 mg of Ativan.
MEDICATIONS:  Dilantin, Fentanyl, Ativan.
INTRODUCTION:  Digital video EEG was performed at bedside using standard 10-20 system of electrode placement with 1 channel of EKG.  The patient is comatose, unresponsive, with intermittent eye blinking.
DESCRIPTION OF THE RECORD:  The background EEG is markedly abnormal and includes multiple electrographic seizures which are clinically associated with eye blink.  Much of the EEG is, in fact, ictal with seizures seeming to wax and wane.  It is difficult at this point to determine when seizures begin and end, but the very first seizure for this patient seems to begin with a burst of rhythmic higher amplitude sharply contoured activity on the left.  Many of the seizures are characterized by high amplitude rhythmic theta-delta or spike-and-wave activity which is essentially bilateral.  Some seizures end with T6 spiking.  Others end with rhythmic sharply contoured activity on the left.  As the recording continues, the seizures begin with faster frequency activity alpha and beta out of the frontal regions and then a paroxysmal evolution.  Some of the seizures do have a clearly defined ending with a slow background and then the T6 periodic sharp waves.  There are sections of the record where there is a T6 sharp wave and a T1 burst of sharply contoured delta.
As the recording continues, more of the epileptiform activity is in the right hemisphere and may be posterotemporal or anterior temporal.
By 12:34, the nurse is providing Ativan.  As the record ends at 12:40, epileptiform activity is noted and has not resolved.
HR:    120 bpm
IMPRESSION:  Markedly abnormal EEG due to:
Multiple electrographic seizures which seem to emanate from the frontal regions but at least in some locations either begin or end with epileptiform activity in the left frontal or even right posterotemporal region.
Interictal epileptiform activity from multiple different localizations including T1, T3, T4, and T6.
Background slowing.
CLINICAL CORRELATION:  This EEG is diagnostic of a complex partial status epilepticus.  Based on these findings, continuous video EEG monitoring was initiated.