FOCAL SZ Flashcards
AT WHAT STAGE OF SLEEP?
The above EEG shows a simple partial seizure that occurred out of stage 2 sleep.
WHAT EPILEPSY SYNDROME?
Interictal EEG manifestations include anterior temporal spikes at 0.5 to 1.5 Hz or rhythmic 2 to 4 Hz facilitated
by drowsiness and light non-REM sleep
MTS
ICTAL EEG PATTERN OF MTS
A frequent ictal pattern of mesial temporal origin is the sudden appearance of localized or regional background attenuation, build-up of 4- to 7-Hz rhythmic activity, increasing in amplitude as it slows to 1 to 2 Hz. This may befollowed by suppression or slow activity.
WHAT SZ TYPE?
Right temporal 6- to 7-Hz rhythmic ictal theta discharge at
seizure onset in a patient with temporal lobe epilepsy
Although it may be difficult to clinically distinguish ________________from mesial temporal lobe seizures, they may have a widespread hemispheric onset, begin in the mid-temporal derivations at <5 Hz, have rapid propagation to extratemporal structures, and have a greater likelihood to secondarily generalize
neocortical temporal lobe seizures
WHAT IS SHOWN?
Left temporal neocortical seizure onset with rhythmic 3-Hz
delta maximal in the mid-temporal derivation prior to rapid generalization
LOCALIZATION OF SZ
Right “focal” temporal seizure confined to the right subtemporal (RST) 1 to 3 electrodes on intracranial recording. L(R)ST = left (right) subtemporal; L(R)LT = left (right) lateral temporal; L(R)OF = left (right) orbitofrontal.
LOCALIZATION OF SZ
Discrete focal seizure onset in a patient with a right frontal
lesion.
___________often has very brief, bizarre, bimanualbipedal automatisms with nocturnal predominance and be prone to acute repetitive seizures and status epilepticus
Frontal lobe epilepsy
WHAT IS SHOWN?
Nonlocalized ictal EEG in frontal lobe epilepsy. Notice the
brief right frontal-central repetitive spikes in seconds 7 to 8
_________are seizures that begin in the mesial frontal lobe and therefore often may have brief and bizarre semiologies that mimic psychogenic nonepileptic seizures (pseudo-pseudoseizures).
The clinical semiology may also manifest a “fencer’s” posture that provides more localizing value than surface ictal EEG (see above) with the side of tonic extension reflecting the side opposite seizure onset
Supplementary motor seizures
WHAT SZ TYPE IS SHOWN?
Diffuse electrodecremental response in a patient with a supplementary motor seizure.
_________seizures are often clinically silent. Somatosensory involvement may yield a perception of tingling, formication, pain, heat, movement, or dysmorphopsia, typically of the distal limb or
face
Parietal lobe
LOCALIZATION OF SZ?
The tracing shows high-frequency, mu-like arcuate waveforms focally over the left parietal C3-P3 derivations at 10 Hz in the region of a brain tumor.
High-frequency discharges at the _______junction can induce contraversive nystagmus and eye and head deviation
temporoparieto-occipital
SZ LOCALIZATION?
Right occipital lobe seizure with a build-up of right occipital
6- to 7-Hz rhythmic ictal theta associated with the patient’s complaint of left visual field loss.
Seizures may occur without awareness or be very subtle such that clinical signs are not noted. These are especially common in patients with complex partial seizures. When testing is performed, some seizures exhibit no evidence of interruption in behavior. Such is the case with brief absence seizures.
WHAT SZ TYPE?
Subclinical seizures
DESCRIBE THIS SEEN IN A PT WITH NO ELECTROGRAPHIC SZ
Subclinical seizure in a patient with encephalopathic generalized epilepsy. There were no clinical signs noted during multiple brief seizures
