Featured Case - December 2017

Featured Case
Contributed by: Sotiris Mitropanopoulos, MD & Lily Wong-Kisiel, MD
Mayo Clinic College of Medicine, Rochester, MN

Clinical Presentation: Video EEG monitoring in a 9 year old suspected of ESES

A 9 year-old right-handed male with neurofibromatosis type 1, attention deficit hyperactivity disorder, intellectual disability with academic plateau, and electrical status epilepticus during sleep (ESES) was admitted to overnight video EEG monitoring for ESES evaluation. He has never had a clinical seizure. The EEG showed seemingly spontaneous focal spike-and-wave discharges coming from both the right and left central regions during wakefulness. These discharges often occurred while the child was playing with the touchscreen tablet or when his palm was tapped repeatedly during play (Figures 1-3). During sleep there was marked activation of independent left and right central discharges typical of ESES.

Figure 1 - Tapping touchscreen with right thumb. EEG: Bipolar montage with a time base 30 mm/sec, sensitivity 20 µV/mm, high frequency filter at 70 Hz, low frequency filter at 1 Hz.

Figure 2 - Tapping touchscreen with left index finger. EEG: Bipolar montage with a time base 30 mm/sec, sensitivity 20 µV/mm, high frequency filter at 70 Hz, low frequency filter at 1 Hz.

Figure 3 - Rhythmic tapping on the right palm. EEG: Bipolar montage with a time base 30 mm/sec, sensitivity 20 µV/mm, high frequency filter at 70 Hz, low frequency filter at 1 Hz.

Question 1: What do these discharges represent?

  1. Interictal activity of childhood epilepsy with centrotemporal spikes.
  2. Tactile-evoked discharges.
  3. Electrode artifact.
  4. Interictal activity of atypical childhood epilepsy with centrotemporal spikes.
Answer & Discussion: (click here)

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