PMC7334590_01
EEG with left-sided focal epileptiform discharges. At presentation, EEG demonstrated abundant (5 in 10 s) high-amplitude left temporo-parietal, occipital and frontal spike and slow wave discharges in the setting of left-sided cerebral dysfunction in the context of normal sleep architecture (arrowhead). Sensitivity: 15 muV/mm, Timebase: 10 s/screen, HFF (high-frequency filter): 70 Hz, LFF (low-frequency filter): 1 Hz.. Legend key: Arrows: epileptiform discharges; Arrowheads: sleep architecture.
gr1.jpg
PMC7334590_01_gr1.jpg
f0005
Her initial 2-hour EEG captured frequent left hemispheric multifocal epileptiform discharges with left-sided focal slowing in the context of normal sleep architecture (Fig. 1).
Multifocal discharges. One day later, EEG demonstrated high-amplitude abundant (> 5 in 10 s) bilateral independent temporo-parietal discharges and bisynchronous spike-and-wave (arrows) in the context of normal sleep architecture (arrowheads). Sensitivity: 15 muV/mm, Timebase: 10 s/screen, HFF (high-frequency filter): 70 Hz, LFF (low-frequency filter): 1 Hz.. Legend key: Arrows: epileptiform discharges; Arrowheads: sleep architecture.
gr2.jpg
PMC7334590_01_gr2.jpg
f0010
Due to change in semiology that was witnessed by the family and our team, a second EEG was obtained, which demonstrated multifocal and bisynchronous spike-and-wave discharges, again with a background containing normal sleep structures (Fig. 2).
Epileptic spasm. High voltage generalized delta followed by an electrodecrement clinically associated with arm extension. Sensitivity: 15 muV/mm, Timebase: 10 s/screen, HFF (high-frequency filter): 70 Hz, LFF (low-frequency filter): 1 Hz.. Legend key: Arrows: epileptiform discharges
gr3.jpg
PMC7334590_01_gr3.jpg
f0015
MRI, a new seizure type described as clusters of bilateral arm extension at the shoulder to 45-90  was observed. Multiple events were captured on EEG, demonstrating epileptic spasms with hypsarrhythmia (Fig. 3, Fig. 4), consistent with IS.