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Hemihypsatthythmia; Herpes Simplex Encephalitis. A 4-year-old boy with intractable epilepsy caused by herpes simplex encephalitis at 2 years of age. His seizure is described as “very frequent clusters of asymmetric tonic spasms with left-sided predominance accompanied by head and eye deviation to the left side, with or without horizontal nystagmus with fast component to the left side.” MRI showed severe encephalomalacia of the entire right hemisphere with mild left cerebral atrophy. Interictal EEG shows a hypsarrhythmic pattern over the left hemisphere with severe background suppression and multifocal sharp waves over the right hemisphere. This EEG pattern is compatible with left hemihypsarrhythmia. The patient showed significant improvement of seizures after the right functional hemispherectomy. Brain pathology can be lateralized to either ipsilateral or contralateral Source: Epileptic Encephalopathy, Atlas of Pediatric EEG hemihypsarrhythmia.31 Citation: Laoprasert P. Atlas of Pediatric EEG; 2011 Available at: http://mhmedical.com/ Accessed: May 05, 2017 Infections are considered to be etiological factors in 10% of patients with infantile spasms (congenital or acquired cytomegalovirus (CMV), congenital Copyright © 2017 McGraw-Hill Education. All rights reserved rubella, herpes simplex virus, enterovirus, adenovirus, meningococcus, pneumococcus, pertussis, and unknown agents). The outcome of children with infectious etiology is poor.76 herpes simplex virus (HSV-1) and varicella-zoster virus (VZV) are the most common causes of sporadic encephalitis in adults and children, respectively.77 Sixty-one percent of children have early seizures and an associated poor outcome.78