Video EEG

Date of Procedure: April 24, 2006
CLINICAL HISTORY: Patient is a 8 month old male with history of infantile spasms. Patient is now having daily episodes of blank staring where the patients pupils were dilated.
Medications: Current medications include Vigabatrin
RECORDING DATA: Scalp electrodes were applied according to the International 10/20 system of electrode placement. Zygomatic electrodes were also used. The recording was made on the stellate digital system.
DIGITAL EEG ANALYSIS: Automatic spike and seizure detection programs were applied.
Findings: background activity: the awake background activity showed posterior dominant delta activity at 2Hz, which were reactive to eye opening and eye closure. No significant background asymmetry was seen. No focal slow wave activity was seen. During the sleep state, mixtures of 1-3 Hz delta and 4-6 Hz theta activities were noted. Sleep spindles and vertex waves appeared bilaterally. Some portions of sleep EEG resembled hypsarrhythmia.
INTERICTAL FINDINGS: Interictally, there was frequent spike wave activity in the right temporal region involving t4-t6. In addition, there was frequent independent spike activity in the left temporal-central-parietal region involving t5-t3-p3. There was also occasional independent spike wave activity in the bilateral occipital regions involving o1-o2-oz..
CLINICAL EVENTS: One cluster of habitual seizures was captured. The seizure occurred on day 1A-3 at 11:05. the seizure occurred during the awake state and was characterized by slight dilation of the pupils and subtle body jerks. the cluster consisted of six spasms and lasted 10 minutes.
ICTAL EEG FINDINGS: Ictal EEG showed diffuse slow-wave activity with minimal superimposition of fast wave activities.
IMPRESSION: This is an abnormal one day video monitor recording. The overall background activity was slow for age. In addition, some portions of sleep EEG resembled hypsarrhythmia. These findings may suggest diffuse neuronal dysfunction. Interictally, there were frequent independent spike wave activities in the right temporal region as well as in the temporal-central-parietal region. There was also occasional independent spike wave activity in the bilateral occipital regions. These findings may suggest increased risk of epileptic seizures arising from these bilateral multiple foci. We captured one cluster of habitual epileptic spasms. The seizure occur ed during the awake state and consisted of subtle body jerks associated with slight dilation of the pupils. Ictal EEg showed diffuse seizure onset.

The interictal and ictal EEg findings were consistent with the diagnosis of infantile spasms. The habitual events that the patient is having may be subtle epileptic spasms. Clinical and neuroimaging correlation is recommended.