PMC6537247_01
EEG of Patient 1. Top: generalized 2 to 3 Hz semirhythmic
delta activity superimposed on rhythmic theta and alpha activity with
patient delirious and perseverating consistent with NCSE and with patient
blinking every second on average (see eye blink artifacts) consistent with
oculoclonic status. Bottom: electrographic (and clinical as
seen on video) resolution of status epilepticus 3 days after dexamethasone
was added to conventional inpatient antiepileptic therapy. Display
parameters: longitudinal bipolar montage (from top to bottom:
left-mid-right-ECG), digital filter bandpass of 1 to 70 Hz, and 60-Hz notch
filter turned on; voltage-time scale is included in the tracing.
10.1177_2324709619848816-fig1.jpg
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ER mildly confused with constant eye blinking. EEG revealed generalized 2 to 3 Hz semirhythmic delta activity superimposed on rhythmic theta and alpha activity with eye blink artifacts occurring at a rate of ~1/s (Figure 1: top). Three days after starting dexamethasone, CEEG showed complete resolution of epileptiform activity (Figure 1: bottom); and her mental status also started to normalize.
EEG of Patient 2. Top: lateralized periodic discharges
(sharp delta waves) over the left hemisphere time-locked to the myoclonic
jerks of the right hand and face (surface EMG recorded over right face)
consistent with epilepsia partialis continua. Note fluctuation of discharge
rate from 1.5 to 2/s to 0.5 to 1/s. Bottom: electrographic
resolution of periodic discharges 3 days after dexamethasone was added to
conventional antiepileptic therapy coinciding with complete control of
clinical seizures. Display parameters: longitudinal bipolar
montage (from top to bottom: left-mid-right-EMG/ECG), digital filter
bandpass of 1 to 70 Hz, and 60-Hz notch filter turned on; voltage-time scale
is included in the tracing.
10.1177_2324709619848816-fig2.jpg
PMC6537247_01_10.1177_2324709619848816-fig2.jpg
fig2-2324709619848816
On day 5, she started having continuous right face and hand jerking and EEG showed 0.5 to 1/s lateralized periodic discharges (sharp waves) over the left hemisphere that were time-locked to the jerks (Figure 2: top). After 3 days on dexamethasone, she became seizure-free (Figure 2: bottom).
EEG of Patient 3. Top: 0.5 to 1/s lateralized periodic
discharges (sharp/delta waves) with maximum voltage over the right
frontocentral superimposed on irregular slow waves and time-locked to the
myoclonic jerks of the left face, arm, and leg consistent with epilepsia
partialis continua. Bottom: electrographic (and clinical as
seen on video) resolution of epilepsia partialis continua 3 days after
dexamethasone was added to conventional antiepileptic regimen.
Display parameters: longitudinal bipolar montage (from
top to bottom: left-mid-right-ECG), digital filter bandpass of 1 to70 Hz,
and 60-Hz notch filter turned on; voltage-time scale is included in the
tracing.
10.1177_2324709619848816-fig3.jpg
PMC6537247_01_10.1177_2324709619848816-fig3.jpg
fig3-2324709619848816
On admission, EEG showed 0.5 to 1/s periodic sharp and delta waves superimposed on irregular slow waves over the right hemisphere with maximum voltage over the right frontocentral region (Figure 3: top). Seizures stopped completely 3 days after initiating dexamethasone (Figure 3: bottom).
EEG of Patient 4. Top: 1 to 2/s lateralized (left >
right) periodic discharges with sharp morphology and superimposed on
semirhythmic delta activity recorded while the patient was stuporous with
intermittent episodes of right lower extremity jerking findings that are
consistent with NCSE without coma with impaired consciousness and focal
clonic seizure. Bottom: Persistence of left frontocentral
0.3 to 0.5/s periodic discharges approximately 5 days after dexamethasone
was added and the patient was already seizure-free. Display
parameters: longitudinal bipolar montage (from top to bottom:
left-mid-right-ECG), digital filter bandpass of 1 to 70 Hz, and 60-Hz notch
filter turned on; voltage-time scale is included in the tracing.
10.1177_2324709619848816-fig4.jpg
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EEG showed 0.5 to 1/s lateralized (left > right) periodic discharges with sharp morphology and superimposed semirhythmic delta activity (Figure 4: top). Four days after dexamethasone was started, all clinical seizures stopped but 0.3 to 0.5/s lateralized periodic discharges persisted in EEG (Figure 4: bottom).