Video Monitoring Recording 02/24/2009

Date of Procedure: Date started: 02/24/2009
Date completed: 02/25/2009

Procedure: 23-hour Video Monitor Recording

Clinical History: This is a 3 yr old child with a history of bilateral perisylvian syndrome, infantile spasms.

Medications: Vigabatrin, continued during the recording

Recording Date: The 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 Nihon Kohden digital EEG system.

Digital EEG Analysis: The automatic seizure-spike detection programs were applied.

Findings: Background activity: The background activity during the awake state consisted of posterior dominant theta activity at 5 Hz. No consistent focal slowing or inter hemispheric asymmetry was noted. During sleep, sleep spindles were noted bilaterally.

Interictal Findings: frequent spikes as well as runs of spike were seen in the left frontal-central-temporal regions involving electrodes F7, T3, and C3, which occasionally showed secondary bilateral synchrony. Additionally, independent spikes were also frequently noted int he right temporal-central-parietal regions. The frequency of interictal epileptiform discharge were more dominant in the left hemisphere and tend to increase while the patient was asleep. However, no ongoing seizures were captured.

Clinical Events: No paroxysmal events were recorded by the family.

Impression: This was a normal video monitor recording.
1) The background activity was diffusely slow for age suggesting diffuse neuronal dysfunction.
2) The presence of frequent interictal spike in the left frontal-central-temporal as well as right temporal-central-parietal which was more dominant in the left hemisphere particularly while the patient was asleep suggested increased risk of epileptic seizure with multi-focal onset.
3) No ongoing seizures or habitual events were captured during the recording.