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AMBULATORY CASSETTE RECORDING EEG MONITORING REPORT EPILEPSY LABORATORY CLINICAL NEUROPHYSIOLOGY LABORATORIES DEPARTMENT OF NEUROLOGY UNIVERSITY OF MICHIGAN Patient: @NAME@ Age: @AGEPEDS@ MRN: @MRN@ Date: @ED@ Referring physician: @ORDPROV@ Introduction: The patient is a @AGEPEDS@ @GENDER@ with a history of ***. This ambulatory cassette recording EEG monitoring study was performed in order to diagnose the etiology of the patient's clinical events. The patient {IS/IS NOT:27046} on neuroactive medications. @NAME@ @CMEDPBRAND@ This recording was obtained using the standard 21-channel 10-20 electrode placement. Single lead EKG monitoring was included. Video recording was utilized during the baseline. Baseline EEG Recording: The baseline was obtained during {wakefulness_drowsiness_sleep_free:304014064}. In the alert state, the posterior background rhythm was a symmetric, well-modulated, *** Hz, *** uV rhythm which reacted symmetrically to eye opening and had a normal frequency-amplitude gradient with an age-appropriate mixture of frequencies. Hyperventilation, performed with {desc; poor/fair/good/excellent:19665} effort, produced physiological slowing. Stepwise photic stimulation at 2-30 Hz evoked symmetric posterior driving responses. No abnormalities were activated by hyperventilation or photic stimulation. During drowsiness there were bursts of diffuse slowing and waxing and waning of the posterior dominant rhythm. During stage II sleep symmetric V waves, K complexes, and sleep spindles were seen. There were no focal or epileptiform abnormalities and no clinical or electrographic seizures occurred during the baseline. The EKG channel revealed no abnormalities. Day 1 - @ED@ Interictal EEG Samples: During wakefulness and drowsiness, the EEG was as described above. Interictal EEG samples during stage II sleep demonstrated symmetric V waves, K complexes, and sleep spindles. The appearance of diffuse delta activity was observed in slow wave sleep. No abnormalities were activated by sleep. Ictal EEG Recording / Patient Events: During this period the patient had no events or seizures. Summary: During this day of recording *** events were recorded. The interictal EEG was {EEG abnormal/normal interpretation:304014062}. Monitoring was continued in order to record the patient’s typical events. The EKG channel revealed no abnormalities. Day 2 - *** Interictal EEG Samples: Interictal samples were identical to those previously recorded. Ictal EEG Recording / Patient Events: During this period the patient had no events or seizures. Summary: During this day of recording *** events were recorded. The interictal EEG was {EEG abnormal/normal interpretation:304014062}. Monitoring was discontinued. The EKG channel revealed no abnormalities. Summary of EEG and Behavior: The interictal EEG was {EEG abnormal/normal interpretation:304014062}. *** of the patient’s typical events were recorded. *** EEG change occurred during the patient’s clinical event(s). Clinical Correlation: This *** day EEG recording was a {EEG abnormal/normal interpretation:304014062} awake and asleep EEG. ***No patterns with a specific correlation with seizures were present, and no focal abnormalities were found. The patient’s typical episodes were recorded and were consistent with ***. *** This EEG was abnormal in {wakefulness_drowsiness_sleep_free:304014064}. 1. *** 2. *** 3. *** ***The disorganized background, with diffuse *** Hz slowing was consistent with a mild/mild to moderate/moderate/moderate to severe/severe encephalopathy. ***The continuous focal slowing over *** was consistent with an underlying structural lesion or a post-ictal state. ***The intermittent focal slowing over *** suggested underlying neuronal dysfunction. The focal sharps/spikes/spike and wave complexes over *** conferred an increased risk of focal seizures arising from this region. ***The generalized sharps/spikes/spike and wave complexes conferred an increased risk of seizures with a generalized onset. ***The multifocal sharps/spikes/spike and wave complexes conferred an increased risk of focal and generalized seizures. ***There were *** seizures recorded, clinically manifesting as ***, and with the electrographic appearance of ***. ***There were *** events recorded, and there was no abnormal EEG change with these events. These were not seizures. ***Overall, this EEG is improved/similar/worse compared to a previous EEG recorded mm/dd/yyyy, because of ***. ***In view of the clinical picture, a recording including sleep/with reactivity testing repeated/ with longer duration to capture spells, etc. could be useful. A normal recording does not exclude the possibility of epilepsy, in this clinical setting, repeat recording could be useful. @MECREDENTIALNOREFRESH@ Epilepsy Fellow This EEG was reviewed with epilepsy attending {ldattending:28131}. Please note this is a preliminary report until signed by the attending. Clinical Diagnosis Code: {lddiagnosiscodesICD9-10:28354}