L1424007_Eeg_16/03/2021 14:18:22

Department of Clinical Neurophysiology

Steelhouse Lane
Birmingham
B4 6NH

Tel: 0121 333 9260

Bch-tr.NeurophysiologyOffice@nhs.net

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NHS Number: 715 504 3672 Test Number: 210480
Patient Name: Sara Ruginescu DOB: 10 July 2016 Sex: F
Referring Clinician: Rodrigues
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Previous test: We recorded one clinical clonic seizure with right arm jerking and 4’ ictal EEG discharge
involving the left centro-parietal region. We also captured a 40” electrographic only seizure again mostly
involving the left hemisphere without overt clinical manifestations.
The EEG is for the rest of the recording grossly diffusely abnormal, with periods of suppression probably drug-
induced interrupted by bursts of asynchronous spike and spike-wave discharges in both hemispheres lasting
3-6 seconds.Professor S Seri, Consultant in Clinical Neurophysiology; GMC Number: 4499565

Family History: Father with epilepsy

Medication: Nil

Reason for Test: 3 episodes of seizure associated around sleep

Patient state: Very upset and distressed but once the electrodes were applied slowly she relaxed. She fell
asleep during the test.

Patient Clinical Information: The above young lady had no seizures for a long time and in 2019, she began to
have episodes where she would waken and tells mum she is going to be sick and vomit. She stares at the
wall and is confused. Mum notes that she has head version and the body would begin to follow, going
around to the right side. Sometimes she claps the hands and sometimes her speech after is delayed/slurred.
All events have been similar lasting 5-10 minutes in total. Afterwards she tends to fall asleep. During the last
episode in January 2021, mum applied an oxygen saturation probe and it read 80% and her HR was
measured at 143. She has coarctation of aorta, aortic arch hypoplasia with IVH and shunt in situ. Mum says
she had a stroke at a few weeks of age and thinks this was over the left side. She was born at full term and
had neonatal seizures. Mum says that motor skills were a little delayed (she lives in a bilingual household)
but she has caught up now and is doing well in school (no regression).

Technical Report

This was a Melatonin Sleep EEG study. 3mg of melatonin was given to the patient to aid sleep capture. A full
set of EEG electrodes were applied (plus mastoids) along with ECG and bilateral deltoid EMG electrodes.

The EEG appears symmetrical whilst awake. The patient was moving a lot whilst awake and there is plenty of
muscle and movement artefacts. Alpha rhythm at 8-9Hz is seen intermittently over the posterior head
regions. It is synchronous, symmetrical and reactive. Theta activity was seen generally over the more central
regions and delta activity also seen over the more posterior regions bilaterally. Irregular sharp and slow
waves were seen over the left posterior region with minimal interhemispheric spread. As the patient became
sleepy, these changes were more discernible and increased in frequency to near continuous discharges.
Sleep features appeared questionably sharpened; the patient reached stage N2 sleep where sleep spindles
were seen bilaterally. On awakening, the EEG returned to its pre-sleep state.
L1424007_Eeg_16/03/2021 14:18:22

Photic stimulation was attempted at a limited number of flash frequencies (1,8 and 15); the patient became
agitated and was trying to get up so this was discontinued.

Clinical Physiologist: Lisa O'Gorman

Clinical Interpretation

EEG recorded whilst awake and during sleep. The background shows excess slow activity in posterior
regions. Normal sleep features are seen.

There are fairly frequent focal, spike-wave discharges predominantly in the left occipital region which
become abundant during sleep with a left posterior temporal/occipital emphasis.

The findings are in keeping with focal epilepsy likely arising left occipitally.
Given the clinical history including emetic and autonomic features during sleep, progression of the
discharges into mesial temporal structures is likely. Whilst a self-limiting focal epilepsy is within the
differential diagnosis, underlying left posterior structural or vascular abnormality may plausibly be
causative.

Dr J Ibrahim ST5 to
Professor S Seri MD, FRCP
Consultant in Clinical Neurophysiology
GMC Number: 4499565
Reported: 16/3/2021