DataConversionToNIX/EDF/00002297_s003.txt

CLINICAL HISTORY:   66-year-old woman admitted on the 21st with complex partial status epilepticus and past history of alcohol abuse and epilepsy.
MEDICATIONS: Topiramate,  Ativan, Depakote, Levetiracetam
INTRODUCTION: Digital video EEG is performed in the ICU using continuous video
EEG monitoring.  No clinical seizures are reported in this session of the record.
IMPRESSION:   Limited pieces of this data were available to review due to technical considerations.  The data available did not identify epileptiform activity, but the entire study was unable to be opened.
LONG-TERM MONITORING- LTM- 07-100
INTRODUCTION: Continuous video EEG monitor is performed initially in the long term monitoring unit at bedside using standard 10-20 system of electrode placement with one channel of EKG.
DESCRIPTION OF THE RECORD:   In the initial portions of the record, relatively frequent seizures are observed some of which occur one briefly after another.  More than 1 ictal pattern is observed but most of the seizures will localize to the right parietal region.  Some began with bursts of fast activity.  Others began with more discrete right parietal spikes and others began with a high amplitude spike in the right hemisphere and then attenuation followed by repetitive activity from the right hemisphere  maximum in the right parotid occipital region.  Examples of these seizures can be seen at 1900 hours.   Over the course of the evening, the patient has a very long period without significant seizures.  Seizures recur in the morning of the 24th beginning at 8:45.  The patient is intubated and the EEG following intubation is slightly discontinuous.  Seizures recur on the afternoon of the 24th but are not sustained. The EKG N/A and not done
with this so we will not do the conclusion.
INTRODUCTION: Continuous video EEG monitoring was performed on the nursing unit using standard 10-20 system of electrode placement with 1 channel of EKG.
Continuous seizure and spike detection software was employed. The clinical team, patient, and the software all identified multiple nearly-continuous seizures in wakefulness.
DESCRIPTION  OF THE RECORD:  Typical seizures are relatively brief in duration. They can begin with either a burst of fast activity identified from the right hemisphere or rhythmic 4 HZ activity from the right parietal occipital region. This is followed by rhythmic activity. The rhythmic activity is most prominent from the right hemisphere, but there is muscle picked up on the left. This lasts approximately 20 seconds duration before periodic high amplitude raggedy sharp activity is identified in the right hemisphere.
Some of this is very high amplitude, and much of it demonstrates  a significant field of spread throughout the right hemisphere including right central and occipital parietal. The typical seizures end with periodic slowing. Some seizures begin with a burst of fast activity observed bilaterally. Most seizures are under a minute in duration. Particularly in initial portions of the record most seizures are associated with some left motor activity, and the vast majority of seizures are in the category of 30-40 seconds duration.
After midnight on the 22nd/23rd the patient reached a stage 2 sleep with spindles and vertex waves. In sleep seizures appear to abate.
Seizure description:  There is variability in terms of this patient's ictal behavior. When the seizures start at the beginning of the long-term monitoring typical features of the seizures can include left facial twitching, left arm distention, left arm tonic-clonic activity, or left leg extension. The patient is tested in the initial portion of the seizures, and she is responsive during the seizures, somewhat aware of them, and describes them as uncomfortable. As time goes on she continues to demonstrate EEG evidence of ongoing ictal activity, but motor activity is a bit less prominent. Feature that remain throughout include eye opening and staring. By the close of this 24-hour epoch she seems to have less in terms of well defined motor and a little bit more in impairment of awareness.
HR: 	72 bpm
IMPRESSION:   This 24-hour EEG recording demonstrates  complex partial status epilepticus which abates only when the patient is sleeping. Of note, the activity from the left hemisphere initially demonstrates  little in the way of slowing, and after exposure to these many antiepileptic medications  there is a bit more slowing in the section of the record which concludes on the morning of the 23rd.