PMC8011035_01
Coronal T2 images of hippocampi (1.5 T, TR = 7094 ms, TE = 87.1 ms). No obvious sclerosis or atrophy was noted.
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MRI of brain with and without contrast was obtained, and did not show radiological evidence of mesial temporal sclerosis or any other pathology (Fig. 1).
Interictal EEG. An interictal EEG during sleep with standard 10-20 placement, bipolar montage, band-pass filter of 1-50 Hz, sensitivity 10 muV/mm, showing spike-slow wave discharges arising from the left temporal region.
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Interictal EEG recordings showed epileptiform discharges in the form of sharp wave and spike-slow wave discharges arising from the left anterior temporal region (Fig. 2).
a-c. Serial ictal EEGs. a. Onset of seizure. EEG during sleep, with the same setting as mentioned in Fig. 1, showing a sharp wave discharge in the left anterior temporal region followed by diffuse background attenuation. The EKG channel showed significant tachycardia at the beginning of the seizure. b. Consolidation of seizure. An EEG epoch showing rhythmic 5-6 Hz sharp waves in the left anterior temporal region. These sharp discharges increased in amplitude and spread to the other temporal channels. This was then superimposed by dense EMG artifact from tonic phase. c. Termination of seizure. Generalized bursts of frontally dominant poly sharp-slow discharges leading to diffuse suppression of the background.
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This activity eventually spread to the right hemisphere, just prior to appearance of diffuse EMG artifact (Fig. 3a, 3b, 3c).