PMC9381751_01
RNS electrothalamogram (ETG) of GTCS. In August 2021, the patient experienced a GTCS. Her family used the RNS magnet (black labels M and XM in the ETS) to store this ETS data in the patient data management system (PDMS). The ETG represents 1 long episode (LE) lasting 90 s. The A1A2 blue labels are the RNS detection of this seizure. The seizure is characterized by rhythmic, beta range, spike-wave discharges (Gain 4x). Note, the patient was not undergoing scalp EEG at the time of this seizure and no direct comparisons between scalp EEG findings and RNS ETS were available.
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F1
Hz, spike- and polyspike-and-wave discharges as well as bursts of GPFA (Figure 1). Her case was reviewed at our patient management conference. Six months after RNS implantation, she experienced a cluster of GTCS that was followed by absence status epilepticus (Figures 1-3).
(A,B) Scalp EEG following GTCS. (A) AP Bipolar montage (15 s; HFF 70 Hz, LFF 1.5 Hz, Sen 10 uV). The tracing reveals nearly continuous generalized polyspike-and-wave discharges. At times, these discharges were intermixed with generalized paroxysmal fast activity (GPFA, B). Note, the ETG captured by RNS and illustrated in Figure 3 do not correspond to these specific scalp EEG examples in (A,B).
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F2
Six months after RNS implantation, she experienced a cluster of GTCS that was followed by absence status epilepticus (Figures 1-3).
(A-D) Non-convulsive status epilepticus (NCSE) on scalp EEG and RNS Findings. The tracing in (A) (AP Bipolar montage, 60 s; HFF 70 Hz, LFF 1.6 Hz, Sen 10 uV) illustrates continuous generalized polyspike-and-wave discharges. Clinically, the patient exhibited impaired cognition and responsiveness. There were no motor features during these EEG changes. The ETG in RNS (B-D) corresponds directly to the EEG 60 s epoch in (A). B reveals the first 10 s of ETG data (gain 4x) corresponding to the first 10 s of scalp EEG data displayed in (A). There are continuous, spike-wave discharges within the left and right CMN contacts. (C) (Gain 4x) reveals the 60 s of ETG data corresponding to the 60 s of scalp EEG data. The blue A1/A2 boxes denote RNS detection followed by a delivered therapy (Tx). During therapy, there is interruption in the ETS background. In (D) (gain 4x), the density spectral array demonstrates bursts of high-power activity that corresponds to the ictal activity (rhythmic, beta range spike-waves) in the ETG tracing (C). The low power (blue/green) in the density spectral array corresponds to delivered therapies (identified in (C) by the Tx blue box).
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F3
Six months after RNS implantation, she experienced a cluster of GTCS that was followed by absence status epilepticus (Figures 1-3).