CLINICAL HISTORY:
MEDICATIONS:  Topiramate, Depakote and Dilantin.
INTRODUCTION:  Continuous  video EEG is performed in the unit using standard 10-20 system of electrode placement with one 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.
IMPRESSION: