Nancy Foldvary-Schaefer, DO, MS, FAASM
CONTINUUM: Lifelong Learning in Neurology. 19(1, Sleep Disorders):104-131, February 2013
Video demonstrates a bilateral, asymmetric, tonic seizure with semiology characteristic of frontal lobe (mesial) activation in a 32-year-old man with a normal MRI, no interictal discharges on scalp EEG, and a nonlocalizable scalp ictal EEG pattern. An ictal SPECT shows hyperperfusion in the left medial frontal lobe, so a stereo EEG evaluation is planned. The patient is medically intractable, with repetitive seizures at sleep-wake transition at bedtime most nights that have not responded to medication. The seizures routinely wake him up, but he typically can recall what happens during the seizure and responds immediately thereafter.