CLINICAL HISTORY:  54 year old male with complex partial status epilepticus with seizures characterized by confusion and poor responsiveness.
MEDICATIONS:  Ativan, Dilantin, Topamax
INTRODUCTION:  Continuous digital video EEG monitoring with seizure and spike detection was preformed at bedside using standard 10-20 system of electrode placement with 1 channel of EKG.  The patient is confused.
DESCRIPTION OF THE RECORD:  The initial section of the record demonstrates at the very beginning a patient who is not seizing, but has had frequent seizures prior to the hookup.  In the first several hours of recording, multiple left frontal seizures are recorded, typically lasting 1 to 3 minutes in duration.  The initial seizures are well-defined with characteristic frequency evolution.  By 6 p.m., the EEG starts to transition to a pattern with fewer seizures, but bursts of left frontal periodic delta.  An additional burst is noted at 8:45, again compatible with a late ictal pattern with buildup of activity.
By 10 a.m., the patient is more awake with eye movement.  There are, however, bursts of left frontal periodic activity.  Some of these including10:37 likely demonstrate a late ictal pattern with the appearance and buildup of epileptiform activity which does demonstrate some frequency evolution.  At 11:51, the patient seems to be drifting off to sleep.  Although clinical testing is not performed, he continues to have these bursts which no longer truly evolve, but are a bit more sustained.
By 2 a.m., the patient seems to be a bit more awake with more faster frequency activity.  Despite this, the same discharges continue to occur with some frequency evolution.  The discharges later in the evening or in the midnight hours may represent an ictal or postictal pattern without the same clear frequency evolution.
Slow paper speed can be utilized to highlight the ongoing epileptiform pattern.  By 6 a.m., slow paper speed indicates an ongoing epileptiform pattern which no longer truly evolves and, in fact, is 1.2 Hz and 2.7 Hz periodicity.  Despite this, by 6:40 a.m. the patient is more awake, alert and interactive.
HR:    90 to 100 bpm.
IMPRESSION:  This EEG is diagnostic of:
An ongoing status epilepticus pattern.
An interesting phenomenon in that the patient does appear to be clinically improving despite the presence of epileptiform activity which has not resolved.
LONG TERM MONITORING – 12/04/2012 to 12/05/2012 - #12-01
INTRODUCTION:  Continuous digital video EEG was performed at bedside using standard 10-20 system of electrode placement with 1 channel EKG.  Continuous seizure and spike detection software is utilized. Clinically the patient is described as improving, with an improving mental status.
DESCRIPTION OF THE RECORD:  The EEG provided begins at noon.  The background is relatively free of well defined complex partial seizures, but these start to re-emerge at 11:00 to 1:00 a.m.  The video is reviewed.  On some occasions prior to the seizures the patient seems to have repetitive speech and then during the discharges, he has motion arrest.  He is intermittently confused.  During examination of the patient the epileptiform activity is not so prominent.
Between 1:00 a.m. and 4:00 a.m. he is moving about a bit which makes identification of the seizures more difficult, but additional seizures are noted at 4:00 a.m. and 5:00 a.m.  The nurse is at the bedside with him during a seizure at 5:04 a.m. on January 5, 2012.  The seizure and spike detection software continues to recognize seizures, including one at 5:06 a.m.  The nurse enters during the seizure and performs vital sign testing.  The patient is unable to answer questions.  He looks at the nurse.  He cooperates with testing, but is unable to speak.
HR:    80 bpm
LONG TERM MONITORING – 01/05/2012 to 01/06/2011
INTRODUCTION:  Continuous  video EEG was performed at bedside using standard 10-20 system of electrode placement with 1 channel of EKG.  Hyperventilation and photic stimulation are performed.  This overnight EEG was recorded in several pieces.
DESCRIPTION OF THE RECORD:  The first section opens on the 5th at 9:32 a.m.  The patient is having left frontal focal seizures.  He stares off into space. He looks to the right.  A person comes in and it is not clear that he is particularly interactive during the seizure.  His mouth is open.  The nurses work with the patient as the seizure stops and he looks about afterwards.  The first piece of long term video EEG monitoring data primarily shows seizures in the early part of the morning.  By 1:07, the patient seems to have received medications.  Seizures again occur and are picked up by the seizure and spike detector and can be seen at 1:52.  There is a montage change to focus on the left frontal region.  Although the patient is no longer seizing in the form of a continuous seizure, there are multiple seizures per hour.
This piece of EEG data concludes at 15:09 p.m.
The second piece of EEG data which begins at 13:27 is not available for review.  The next available data is at midnight on the night of the 5th.  The EEG continues to demonstrate seizures from the left frontal region.  As was the case in the previous night, seizures are quite common at 1 a.m. for this individual and there is once again a pattern of almost continuous ictal activity.  This is again noted at 3 a.m.  It appears to be slowing at 6:21 a.m., but seizures recur at 6:28 and 6:37.
Intermittent seizures or left frontal plebs are noted throughout the remainder of the record.  The EEG on the morning of the 6th continues to demonstrate intermittent seizures and plebs.  The patient is, however, sometimes responsive particularly when the seizures end.
INTERVAL IMPRESSION/CLINICAL CORRELATION:  Ongoing complex partial seizures, particularly problematic between 11 and 1:00 a.m., but occurring sporadically
throughout this LTM monitor.  The last seizure is at 6:17.  This remains a very highly epileptogenic focus.