FOCAL SZ

Question 1

AT WHAT STAGE OF SLEEP?

Answer 1

The above EEG shows a simple partial seizure that occurred out of stage 2 sleep.

Question 2

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

Answer 2

MTS

Question 3

ICTAL EEG PATTERN OF MTS

Answer 3

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.

Question 4

WHAT SZ TYPE?

Answer 4

Right temporal 6- to 7-Hz rhythmic ictal theta discharge at

seizure onset in a patient with temporal lobe epilepsy

Question 5

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

Answer 5

neocortical temporal lobe seizures

Question 6

WHAT IS SHOWN?

Answer 6

Left temporal neocortical seizure onset with rhythmic 3-Hz

delta maximal in the mid-temporal derivation prior to rapid generalization

Question 7

LOCALIZATION OF SZ

Answer 7

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.

Question 9

LOCALIZATION OF SZ

Answer 9

Discrete focal seizure onset in a patient with a right frontal

lesion.

Question 10

___________often has very brief, bizarre, bimanualbipedal automatisms with nocturnal predominance and be prone to acute repetitive seizures and status epilepticus

Answer 10

Frontal lobe epilepsy

Question 11

WHAT IS SHOWN?

Answer 11

Nonlocalized ictal EEG in frontal lobe epilepsy. Notice the

brief right frontal-central repetitive spikes in seconds 7 to 8

Question 12

_________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

Answer 12

Supplementary motor seizures

Question 13

WHAT SZ TYPE IS SHOWN?

Answer 13

Diffuse electrodecremental response in a patient with a supplementary motor seizure.

Question 14

_________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

Answer 14

Parietal lobe

Question 15

LOCALIZATION OF SZ?

Answer 15

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.

Question 16

High-frequency discharges at the _______junction can induce contraversive nystagmus and eye and head deviation

Answer 16

temporoparieto-occipital

Question 17

SZ LOCALIZATION?

Answer 17

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.

Question 18

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?

Answer 18

Subclinical seizures

Question 19

DESCRIBE THIS SEEN IN A PT WITH NO ELECTROGRAPHIC SZ

Answer 19

Subclinical seizure in a patient with encephalopathic generalized epilepsy. There were no clinical signs noted during multiple brief seizures