CLINICAL: A 7-month-old infant with seizures relating to severe lissencephaly. Previous routine EEG 12/07/11 demonstrated multifocal sharp waves and diffuse relative background attenuation and slowing, though not satisfying all criteria for hypsarrhythmia.
TECHNIQUE: A 6-hour 18-channel outpatient video EEG telemetry recording.
The study started at 8:46 a.m. and completed 2:15 p.m. The study contains numerous, fairly prolonged clusters, very apparent infantile spasm. Each spasm is very brief, lasting perhaps 0.5 seconds, with flexion at the hips and elbows and slight shoulder adduction, often with eyes wide open and an apparent blank stare. There is only very subtle trunk muscle involvement. The majority of the clusters are associated with a discontinuous background with apex of relative attenuation lasting 1-2 seconds. The background is seen also during stretches of the study and even on occasion during sleep. There are multifocal sharp waves and pikes of variable morphology and very high amplitude and the background is generally characterized by chaotic theta and delta slowing. The spasms are not time-locked to periods of attentuation or spikes. Sleep architecture is poor, though at times there is some spindle activity at the vertex. The waking background is also continuously abnormal.
IMPRESSION: This is an abnormal video EEG telemetry recording, capturing numerous clusters of apparent infantile spasm. The background shows hypsarrythmia for the majority of the study and is continuously abnormal. The study is very consistent with symptomatic infantile spasm.
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