PMC4049430_01
(A) Seizure with a left frontotemporal focus. Ictal electroencephalography (EEG) showed rhythmic and reluctant fast (12-13 Hz) activity primarily involving the left frontotemporal area consisting of polyspikes of about 100 mV amplitude with reversal phase in the F7 lead, then epileptic discharge involved all channels and showed a reduction in frequency (6 Hz). The patient was unconscious. Discharges consisting of high-amplitude sharp waves (90-100 muV) and slow waves (prominent on the frontotemporal areas) (high 30 Hz, low 0.1 second; rate 15 mm/second). (B) EEG during pseudoseizures. Normal background activity with interictal abnormalities in left frontocentrotemporal channels: sporadic and nonperiodic sharp waves at 100 mV with reversal phase on F7 and sporadic anterior synchronous and asynchronous theta activity (6-7 Hz, 50-60 mV). Muscular artifacts on right frontal derivations and two abrupt movement artifacts were concomitant with fictitious spasms of the patient. No epileptic seizures were recorded. This recording showed a significant reduction of interictal activity in comparison with her previous EEGs.
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Immediately, EEG monitoring (Figure 1B) was performed, and it revealed no ictal abnormalities during these episodes, but only sporadic interictal sharp waves noted at baseline, supporting a diagnosis of NES.