Epilepsy Report Generator


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Technical Summary

Technical Summary

Lethargic

This is a 200 Hz digital EEG with ECG monitoring performed in the lethargic state.   Hyperventilation and photic stimulation were not done.  Digital EEG was referentially recorded, reformatted and digitally filtered in a variety of bipolar and referential montages for optimal display.

Comatose

This is a 200 Hz digital EEG with ECG monitoring performed in the comatose state.   Hyperventilation and photic stimulation were not done.  Digital EEG was referentially recorded, reformatted and digitally filtered in a variety of bipolar and referential montages for optimal display.

Description of Record

Normal

Normal

Awake and Drowsy

During the maximally alert state, a XX Hz, XX microvolt posterior dominant rhythm was seen which was symmetrical, well regulated and briskly attenuated to eye opening.  In the more anterior head regions, symmetric frontocentral 14-18 beta frequencies predominated.  As drowsiness occurred, the posterior dominant rhythm attenuated, slow rolling eye movements appeared and increased frontocentral beta and high amplitude, and symmetrical vertex sharp transients were seen.  Later stages of sleep were not attained.

Awake and Sleep

During the maximally alert state, a XX Hz, XX microvolt posterior dominant rhythm was seen which was symmetrical, well regulated and briskly attenuated to eye opening.  In the more anterior head regions, symmetric frontocentral 14-18 beta frequencies predominated.  As drowsiness occurred, the posterior dominant rhythm attenuated, slow rolling eye movements appeared and increased frontocentral beta and high amplitude, and symmetrical vertex sharp transients were seen.  Stage 2 sleep was reached characterized by high amplitude K-complexes and 14 Hz symmetrical and synchronous frontocentral sleep spindles.  Later stages of sleep were not attained.
Abnormal

Abnormal

Generalized Slowing (Delta with frequent Theta)

At the maximally alert state, there was no well-formed posterior dominant rhythm appreciated. The background consists of continuous generalized polymorphic delta (2-3 Hz) of XX microvolt. There is frequent intermixed theta (4-6 Hz) activity. The background is XX reactive to external stimuli of auditory and tactile stimulus. No electrographic or clinical seizures were recorded. No well-formed sleep architecture was seen.

Generalized Slowing (Theta)

No PDR
At the maximally alert state, there was no well-formed posterior dominant rhythm appreciated. The background consists of continuous generalized polymorphic theta (4-7 Hz) of XX microvolt. The background is XX reactive to external stimuli of auditory and tactile stimulus. No electrographic or clinical seizures were recorded. No well-formed sleep architecture was seen.
Brief PDR
During the maximally alert state, a XX Hz, XX microvolt posterior dominant rhythm was seen briefly. The background consists of continuous generalized polymorphic theta (4-7 Hz) of XX microvolt. The background is XX reactive to external stimuli of auditory and tactile stimulus. No electrographic or clinical seizures were recorded. No well-formed sleep architecture was seen.
Focal Slowing (Theta)
The background is asymmetric; with left hemisphere consists of near continuous generalized polymorphic delta (2-3 Hz) of 30-40 microvolts. There are also left temporal independent spike discharges maximum at T7. During the maximally alert state, a 8.5-9 Hz, 35-45 microvolt posterior dominant rhythm was seen which was asymmetrical seen well on right hemisphere, well regulated and briskly attenuated to eye opening. As drowsiness occurred, the posterior dominant rhythm attenuated, slow rolling eye movements appeared and increased frontocentral beta and high amplitude, and symmetrical vertex sharp transients were seen.  Later stages of sleep were not attained.
 
Other Qualifiers
Normal
Mu rhythm at XX Hz was noted over the XX central area.
Posterior slow waves of youth were seen over the occipital regions.
POSTS were noted over the occipital regions bilaterally.
Several sharp transients were seen in the left temporal region (T7), which were likely wickets, a normal variant.
Normal variants seen during this recording include wicket spikes, rhythmic temporal theta bursts of drowsiness, 14&6 Hz positive bursts, benign epileptiform transients of sleep, 6 Hz spikes (phantom spikes, FOLD), lambda waves, shut eye waves, cone waves, rhythmic midline theta of Ciganek, subclinical rhythmic EEG discharge of adults (SREDA)
Fragments of sleep architecture, including vertex sharp waves and poorly formed sleep spindles were seen.
 
Abnormal
Generalized excessive beta activity was seen.
Fast and sharp activity in the left centro-temporal region at Cz, C3 and T7, was seen consistent with a breach rhythm due to the patient’s known skull defect.
Frontal intermittent rhythmic delta activity (FIRDA) was seen.
Intermittent 1-2 Hz frontally-dominant reactive triphasic waves are seen.
Continuous 1-2 Hz  periodic waveforms waxing and waning were seen that were more consistent with triphasic waves prominent because of the morphology, frontal positivity, AP and PA lag, and reactivity.
 
Epileptic
Generalized anterior predominant synchronous 3-3.5 Hz spike and wave activity was seen lasting from 2-5 seconds.
There were several, generalized, anteriorly predominant, symmetric and synchronous, 4-5 Hz spike and slow wave discharges.
Superimposed on the delta background were relatively irregularly occurring, generalized, frontally predominant, quazi-periodic epileptiform discharges (BiPEDS/GPEDs) were seen. These occurred once every 1 to 2 seconds.

Hyperventilation

Hyperventilation
No HV
Hyperventilation was not performed.
HV Attempted
Hyperventilation was attempted but not completed successfully.
W/o Slowing
Hyperventilation was performed with good effort.  HV did not induce significant EEG changes compared to baseline.
W/ Slowing
Hyperventilation was performed with good effort.  XX Hz slowing was seen during HV but resolved within XX seconds of normal breathing.  The slowing was paroxysmal/of gradual onset and was intermittent/continuous.
W/ Slowing
Hyperventilation was performed with good effort.  XX Hz slowing was seen during HV that was paroxysmal and was intermittent.
W/Slowing and Notched Delta
Hyperventilation was performed with good effort.  Initially XX Hz high-amplitude notched delta activity was seen generalized maximal bifrontal.  The notched nature of the slowing is felt to be more likely due to superpositioning of frequencies rather than true spike-and-wave discharges.  The slowing was of gradual onset and was intermittent.   The slowing resolved within 80 seconds of normal breathing.
W/3Hz Spike-Wave Activity
Hyperventilation was performed with good effort.  Generalized 3 Hz spike and wave activity lasting 10 seconds was seen without any clinical correlation (as noted by the EEG technician).

Photic Stimulation

Photic Stimulation
No PS
Photic stimulation was not performed.
W/o Driving
Photic stimulation was performed from 1-30 Hz.  Photic driving was not observed.  No electroretinogram artifact, photomyoclonus or photoparoxysmal responses were recorded.
W/ Driving
Photic stimulation was performed from 1-30 Hz.  Photic driving was observed.  Driving was bioccipital, symmetrical and best seen at flash frequencies from XX to XX Hz.  No electroretinogram artifact, photomyoclonus or photoparoxysmal responses were recorded.
w/driving (no Hz specified)
Photic stimulation was performed from 1-30 Hz.  Symmetric bioccipital photic driving was observed.  No electroretinogram artifact, photomyoclonus or photoparoxysmal responses were recorded

Clinical Correlation

Normal

Normal

This is a normal electroencephalogram (EEG) record. A normal EEG does not exclude the possibility of epilepsy.  If the clinical suspicion of epilepsy is high, a repeat EEG after sleep deprivation or a seizure may increase the frequency of detecting epileptiform discharges.
 
Other Qualifiers
The breach rhythm is most likely due to the patient’s known skull defect.
Abnormal Encephalopathy

Abnormal – Encephalopathy

Global Cerebral Dysfunction Mild
This EEG is consistent with mild, nonspecific and non-localizing cerebral dysfunction. No seizures or epileptiform discharges were noted.
 
Global Cerebral Dysfunction Moderate
This EEG is consistent with mild-to-moderate, nonspecific and non-localizing cerebral dysfunction. No seizures or epileptiform discharges were noted.
 
Global Cerebral Dysfunction Severe
This EEG is consistent with moderate-to-severe, nonspecific and non-localizing cerebral dysfunction. No seizures or epileptiform discharges were noted.
 
Global Cerebral Dysfunction Non-Reactive
The nonreactive background slowing is indicative of a severe, nonspecific and non-localizing encephalopathy. No seizures or epileptiform discharges were noted.
 
Global spindle coma
The nonreactive background, electro-decrements, and spindle coma are indicative of a severe, nonspecific and non-localizing encephalopathy.  Spindle coma can be associated with head injury, non-traumatic intracranial hemorrhage, and cerebral anoxia in addition to other causes.
 
Pharmacological-induced coma
This EEG is consistent with moderate-to-severe, nonspecific and non-localizing cerebral dysfunction.  The burst suppression pattern may be due to pharmacological-induced coma but may be present without the pharmacological intervention hence underlying pathological process cannot be ruled out.  These findings were discussed with the primary team.
 
Regional Cerebral Dysfunction Moderate
This EEG is consistent with right/left XX nonspecific mild-to-moderate cerebral dysfunction and may correlate with a structural abnormality. A nonepileptiform EEG does not exclude the possibility of epilepsy.  If the clinical suspicion of epilepsy is high, a repeat EEG after sleep deprivation or a seizure may increase the frequency of detecting epileptiform discharges.
 
Other Qualifiers
There were two generalized sharp transients which were not convincing for pathological epileptiform discharges.
Abnormal - PNES
This evaluation is consistent with a diagnosis of psychogenic non-epileptic seizures (PNES). Episodes of XX were without a scalp EEG correlate. Although the lack of an scalp EEG correlate does not exclude a simple partial seizure, the very atypical movements may suggest a nonepileptic event.
A nonepileptiform EEG does not exclude the possibility of concomitant epilepsy. If clinically indicated, an inpatient video-EEG evaluation (EMU) might be considered.

This evaluation was diagnostic for psychogenic/nonepileptic seizures.  The lack of ictal and interictal epileptiform abnormalities supports this diagnosis.
More than 10 events were captured, all of which were similar but none of which were stereotypic.  They consisted of tremulousness, some body jerks, upper extremitiy tremor, visual and auditory hallucinations, restlessness, and occasional gaze preference to the left lasting minutes to hours.  There was no clear scalp EEG correlates.
The XXX was/were discontinued.  It is recommended that the patient not be treated with any medications for treatment of epileptic seizures.  The patient should also follow full seizure safety precautions until these nonepileptic/psychogenic seizures are under control.  Patient not to drive until event free for 6 months. If the patient has or develops other types of spells concerning for epileptic seizures, then the patient should undergo a re-evaluation to further characterize those spells.  The patient to be discharged in stable condition and plan to follow-up with neurology, psychiatry and cognitive behaviour therapy.
Abnormal - Epileptic

Abnormal – Epileptic

Simple Partial
The clinical significance of the right facial twitching is unclear. This EEG provides a non-epileptic basis for the recorded events. Simple partial motor seizures, which rarely have a scalp EEG correlate, cannot be ruled out.  Clinical correlation is recommended.
 
Generalized
This EEG is consistent with interictal and ictal expression of symptomatic generalized epilepsy. Clinical correlation is recommended.
The presence of generalized discharges increases the risk of generalized seizures (e.g., absence, myoclonic and tonic-clonic) and with the normal background, would be most consistent with a high risk for an idiopathic generalized epilepsy syndrome. The possibility of a focal discharge (e.g., frontal) with very rapid spread (i.e., secondary bilateral synchrony) cannot be absolutely excluded but seems much less likely.
 
JME
This EEG is consistent with an interictal expression of an idiopathic generalized epilepsy syndrome. The morphology and frequency of the discharges is consistent with juvenile myoclonic epilepsy.
 
Partial
This EEG is consistent with interictal expression of partial epilepsy with left temporal epileptogenicity. Clinical correlation is recommended.
 
This EEG is consistent with interictal expression of partial epilepsy with independent left and right occipital epileptogenicity. Clinical correlation is recommended.
 
Focal Discharges
The focal epileptiform discharges (right temporo-occipital and left frontocentral) increase the risk of focal and/or secondarily generalized seizures.
 
TIRDA
The right temporal intermittent rhythmic delta activity (TIRDA) is thought to increase the risk of focal and/or secondary generalized seizures (similar to the risk with focal epileptiform discharges). Clinical correlation is recommended.
 
PLEDs
No electrographic or clinical seizures were recorded. The presence of pseudo-periodic, lateralized, epileptiform discharges (PLEDs) increases the risk of acute focal and/or secondarily generalized seizures. PLEDs are typically associated with acute/subacute structural abnormalities (stroke, abscess, etc.) and concomitant metabolic/toxic/infectious disorders. Clinical correlation is recommended.
 
FIRDA
Symmetric frontal intermittent rhythmic delta activity (FIRDA) was observed. Symmetric FIRDA is associated with metabolic abnormalities, midline lesions, and hydrocephalus. Clinical correlation is advised.
Asymmetric frontal intermittent rhythmic delta activity (FIRDA) was observed. Asymmetric FIRDA is associated with underlying structural brain abnormalities and also present in metabolic abnormalities, midline lesions, and hydrocephalus. Clinical correlation is advised.
 
Triphasic wave
The presence of triphasic waves is nonspecific but suggestive of a global toxic-metabolic encephalopathy.  The diagnostic use of lorazepam to identify a change in the clinical and electrographic pattern may be of help in the differential diagnosis. Triphasic waves are a nonspecific indicator of a moderate degree of encephalopathy and can indicate renal or hepatic dysfunction.  There was no clear evidence of non-convulsive status epilepticus.
Abnormal - Subclinical
One brief left temporal electrographic/subclinical seizure was seen, without obvious clinical correlate. This would be consistent with a focal epilepsy syndrome with a very high risk of focal and/or secondarily generalized seizures.
Other Qualifiers
Cerebral Dysfunction
in the setting of mild, nonspecific global cerebral dysfunction.
 
Excessive beta
The excessive beta is likely a medication side-effect, and can been seen with benzodiazepine and barbiturate administration.
Brain Death
This is a 200 Hz digital EEG with ECG monitoring performed in the comatose state.  Hyperventilation and photic stimulation were not done.  Digital EEG was referentially recorded, reformatted and digitally filtered in a variety of bipolar and referential montages for optimal display.  A standard ECI protocol was used.
There was no cerebral EEG activity greater than 2mv using a standard ECI protocol.
The lack of cerebral activity greater than 2mv using a standard ECI protocol is consistent with, but not diagnostic of clinical brain death.  The Neurocritical care team was informed of these findings immediately.

Other Note Snippets

Seizure Precautions
I recommended following full seizure precautions including no driving, no baths, no swimming, no working at heights, no work with potentially dangerous equipment and no activity that might injury self or others if a seizure did occur. We also discussed the Texas laws and obligations regarding driving restrictions after having had a seizure.
 
He was discharged in stable condition, given strict seizure precautions, and advised that he is obligated to contact the Texas DPS/DMV in order to update his medical status with respect to driving.
Seizure free
Given that *** has been seizure free for over 6 months, she does not need to follow full seizure precautions.  She can start driving provided *** is compliant with her anti-seizure medications, clinical appointment and lab work relater to her epilepsy.
 
Given that *** has been seizure free for over 6 months, she does not need to follow full seizure precautions.  However, given that she was off her medications during this evaluation, we recommended to not drive and follow full seizure precautions until ***.  The patient was discharged in stable condition and will follow-up with *** in the ***.
 
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