Tips and Tricks for Optimal Review of an Ictal EEG

[@docbrain2764]

seriously, i had a phobia of `EEG`, but after watching your videos, now I am much relaxed and satisfied that i can pick things now. keep it up.

[@researcherhaht]

Thanks for this video, long time , please continue, and make regular works

[@jalaluddinmuhammadrumi5980]

Thank you so much dear

[@alamirewalebachew25]

❤❤❤❤

[@chrismaynard5609]

Thank you, very helpful!

[@h.q.1736]

Thank you very much

[@pixie89]

👍🏻

[@NNaadah]

Hello, I've been watching several of your EEG videos and I have a question about how to pick out a seizure on someone who appears to have non convulsive epilepsy? I have a 20 year old son who's had an epilepsy diagnosis for 17 years and to date; no one has been able to identify his seizures. The closest they've gotten was a couple of myoclonic jerks on a LTM-EEG when he was 6 years old and atypical absence eye fluttering on another LTM-EEG when he was 14. He has been to UB (Buffalo), Cleveland Clinic and Penn State. Very first LTM-EEG showed consistent epileptiform discharge in left temporal lobe of the brain; sleep or waking. Standard MRI found "incidental venues angioma / posterior left temporal lobe" First diagnosed with "complex partial seizures" though EEG's had not caught an easily recognizable seizure. Though they had caught a lot of autonomic odd activity which consisted of strange stereotyped behavior in sleep and jerking motions. He'd been sent for 4 sleep studies over the next 10 years; all turned up nothing that could be attributed to a known sleep disorder; despite the sleep clinic observed the odd behavior too. Sleep clinic also noted multiple arousals out of stage two sleep; reasons not able to identify. (Like 200 in a 6 to 8 hour sleep cycle.) The EEG had been normal on medication until about 3 years ago and then the first manifestation was slowing of the brain waves in the left temporal lobe began to be picked on on the EEG while on meds. Then random short (a couple of seconds) epileptiform discharges in unpredictable pattern in various parts of the entire brain (although not all at once). Most recent EEG (Cleveland February 2022) = epileptiform discharges starting left temporal, spreading right temporal, same random unpredictable pattern short spike wave discharges appearing in random places across the rest of the brain. Current diagnosis "intractable generalized epilepsy of unknown seizure presentation" 3 different doctors say they think it's genetic. (All genetic testing has turned up nothing.) There's no evidence of mitochondrial issues. (Mitochondrial genetic testing also turned up nothing.) With current EEG, doctors are questioning if he has more than one form of epilepsy? Yet still unable to identify a known clinical (shaking) seizure. Which, appears to be what they are looking for assuming it's a "generalized epilepsy". (Which I'm not convinced that it is.) Current clinical presentation is short term memory issues, history of language processing problems, (caused severe learning issues = inability to attain high school diploma), mildly ataxic muscle tone has progressed into tremors of the extremities. Tremors, memory, ability to understand and respond when spoken to, all get markedly worse when off seizure meds. Only pharmaceuticals he's taking are vimpat and depekote. Reasoning IQ scores in the 90's. Memory IQ subsets in the high 50's low 60's. Combined IQ score is 84. He is not intellectually disabled. I think there is probably a temporal lobe epilepsy; with possible secondary generalization. Though the EEG pattern is obviously unusual as well as abnormal to the indication of epilepsy. A few epileptologists have told me they've never seen an EEG that looks like his. The seizure manifestation to me, seems to be cognitive temporal lobe seizures with some sort of impact (spread) into the motor centers of the brain. (I'm guessing parietal lobe, because there's no indication of interference with autonomic nervous system function; so not likely to be affecting cerebellum or brain stem.) That seems to make the most sense to me; given what we know of his brain structural abnormality and developmental history. Although I acknowledge the possibility that he may have more than one form of epilepsy.. So is it even possible to identify a non convulsive seizure on an EEG? (Particularly cognitive seizures?) Thanks!

[@EEGucation]

A bit of information that may help. Some seizures, depending on the seizure generator may not have a clear correlate on the EEG. There can be (not necessary) more than one seizure generators. Genetic testing keeps getting better. Considering all the new genetic tests that become available from time to time it is always worth considering repeat genetic testing. An important discussion to have with the epileptologist is how to improve the patients quality of life. Sometimes more medications and other times LESS medications can offer a better quality of life.

[@NNaadah]

@@EEGucation - The round of genetic testing was completed in the past 18 months so, we have at least another year to wait before they can rerun their results. In the mean time, there has to be tests that can be done to know whether or not the angioma in his brain is causing seizures. (According to the current EEG; that appears to be the case.) We could wait another 20 years for genetic testing to tell us the activity in the temporal lobe is not a genetic issue! (The random generalized discharges might be genetic?) Yet in the mean time, the kid's quality of life continues to decline. He's been on at least 6 different medications now. (It's been 17 years.) Do you have any suggestions on other tests to run to answer this question concerning the temporal lobe and the angioma in the temporal lobe? My next suggestion for the current neurologist is to run a high resolution (epilepsy factored?) MRI to look for atrophy in the brain that wold be consistent with a temporal lobe epilepsy. The kid has had two (maybe 3?) standard MRI's done in his life. The first when he was about 4 years old and the most recent was early 2019. Both noted the presence of the venas malformation posterior left temporal lobe. The 2019 MRI noted a calcium deposit on the midline (fauk division?) frontal cortex. No one has raised that as a concern though. And there's not steady epileptic activity coming from the frontal lobes so I would agree, that I don't think the calcium deposit is part of the issue. Yet, regardless of what the genetics ever say; we have to answer this question as to whether or not this cluster of malformed veins is part of the problem.

[@shachisingh852]

Where are part 6,7,8,9,10?🙄

[@imadversatile007]

Hello sir, I am Neurology resident @ Mayo hospital Lahore, Pakistan. KZbin videos are excellent. Sir, how can I access your website without having university Account?

[@shardachavhan2215]

EEG Training center kha hai sir nagpur ke pass ho