PMC9062418_01
Interictal epileptiform discharges in the first awake scalp EEG with average reference montage. Note the isolated left temporal sharp wave, with maximum at T3 (A), and left temporal sharp waves, with maximum at T3, overlaying intermittent moderate-amplitude irregular slow waves (B) seen once during a 30-minute outpatient EEG session.
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Interictal EEG recordings showed intermittent sharp waves distributed from the left frontal to anterior temporal regions (Fig. 1).
Exercise-induced reflex seizure. The EEG of an exercise-induced reflex seizure in Trial 1 on Day 1 is shown. The same EEG is shown with different montages: (A) average reference montage; (B) longitudinal bipolar montage. The patient experienced a cephalic aura ( ) at 11 seconds after the onset of shadowboxing. Next, his right hand froze ( ), and moderate amplitude rhythmic theta waves (underlined) appeared intermittently during versive seizures (*). During the seizure, he could not reply to the examiner ( ).
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We detected the exercise-induced reflex seizures four times only during shadowboxing with right-sided controlled punching (see Fig. 2 and the attached video online).