Neurophysiology Clinical Case Scenario
A 42-year old right-handed woman was referred to the clinical neurophysiology laboratory for a follow up routine EEG with a history of drug resistant epilepsy. At the age of 8 months she had two febrile seizures in one day. They consisted of generalised tonic-clonic activity lasting for 1 to 2 hours. 9 years later, she had another episode of seizure. She woke up to find herself out of bed, chewed tongue and blood on the pillow. She was admitted to the hospital and was discharged on carbamazepine. From then on, she would have seizures at night mainly in sleep.
Seizure semiology: Presently, wakes up, asks where her daughter is and where are other people and becomes confused. Post seizure started to experience headaches. 99% are nocturnal seizures.
Her husband confirms the above. He reports that previously her right arm would elevate and she would have chewing automatisms. Then she would have a colour change to a dusky blue colour. Seizures last several minutes. Afterwards she would have a glazed expression and would ask unusual questions such as “is everything
alright?”, “where are the kids?”. She is fully amnestic of these episodes.
Infrequently, she has an aura if the seizure occurs in the daytime. This comprises hyperosmia followed by an ascending nausea and vomiting, fear, heart starts racing and heavy drooling. She will walk off or get away from where she is. Then she loses consciousness.
Numerous medications including carbamazepine, phenobarbital, phenytoin, valproate and gabapentin have been tried in various combinations without effective seizure control. No episodes of status epilepticus. She had no other seizure risk factors such as head injury, CNS infection or family history of seizures. Precipitants for seizures are
fatigue, stress, and sleep deprivation.
Question: 1000 words
On the basis of the patients’ history, discuss the various EEG findings you would expect to find in each of the types of seizures she has experienced.