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Stroke Doc
Stroke Doc, Board Certified Physician
Category: Neurology
Satisfied Customers: 48
Experience:  I am board-certified in Neurology and the subspecialty Vascular Neurology.
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I had an EEG done. My neurologist gave me the the result but

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I had an EEG done. My neurologist gave me the the result but I did not understand a word of what she was saying and there was no time to ask her questions. I was hoping you could put the report in layman's terms. I would greatly appreciate it. Here is the report:

The patient is a 39 year old woman evaluated for starring spells. The patient has a complex psychiatric and medical history and reports that about a year ago she started having starring spells. They include loss of time. The patient is not aware that she had one until after the event and witnesses tell her that she stares straight ahead and does not respond to anywhere form 30 seconds to 2 minutes. The events occur 3-4 times a week and she may have several at times in a single day. Afterwards, she has a pounding headache in the right side of the head and she had to lie down for a few hours. She had and episode at church where she stood , lost feeling in her legs and fell and since the her legs have been weak and has trouble walking. She is primarily wheelchair at this bound point. Howerver, once the patient was asked to walk to the hospital bed she did very well.

This was a 24 hour hour ambulatory EEG on a 39 year old woman. The posterior background rhythm was a fairly low voltage 10-11 hertz aplha rhythm. Theta activity obscured mmost of the background. Amplitude nEver exceeding 5-10 mv. Muscle artifact was seen in abundance and occassional wickets are noted. The patient had several episode described as "starring" and feeling numb while talking", chest pain and headaches none of which have any EEG correlate. Intermittent left temporal slowing in the theta delta frequency range and at times at bitemporal slowing were during the study. No clear epileptiform activity was noted. Sleep was heraled by vertex and spindles.

IMPRESSION: THIS WAS A TECHNICALLY DIFFICULT 24 HOUR AMBULATORY EEG DUE TO THE AMOUNT OF ARTIFACT NOTED DURING WAKEFULNESS BUT THIS WAS PRIMARILY REMARKABLE FOR BITEMPORAL SLOWING SUGGESSTIVE OF FOCAL DYSFUNCTION IN THAT AREA NONSPECFIC AS TO CAUSE. THE LEFT SIDE WAS MORE PROMINENTLY IMPLICATED. NO EPILEPTIFORM ACTIVITY OR SEIZURES WERE RECORDED. SOME OF THE PATIENT'S TYPICAL EVENTS INCLUDING STARRING SPELLS AND PAIN BEHING THE RIGHT EYE, AND FEELING NUMB WHILE TALKING WERE RECORDED NONE OF WHICH WERE ASSOCIATED WITH ANY EPILEPTIFORM OR SEIZURES.


She told me it was just my emotions. Go see someone about my emotions and uped my Topamax for my migraines. What do think? What are wickets and artifacts?
Submitted: 2 years ago.
Category: Neurology
Expert:  Stroke Doc replied 2 years ago.

When we read EEG's, we look at your brain waves. The "background rhythm" is the wave frequency that your brain is normally at when you're eyes are closed but you're fully awake. Based on the frequency of your brainwaves, they may be classified as beta (>12 waves per second), alpha (8-12 waves per second), theta (4-7 waves per second), or delta (< 4 waves per second). The normal background rhythm should be in the alpha frequency range. Your's was 10-11, which is normal. The amplitude of the brainwave is typically in the 10-20 microvolt range. Your amplitude was essentially normal.

 

"Artifact" refers to anything that makes it difficult to properly interpret a study. For example, your EEG has "muscle artifact." When muscles (in this case, muscles on your scalp, such as the temporalis muscle) contract, they cause areas of dark squiggly lines on the EEG that have a much higher frequency than your brain in its normal state could ever achieve. Because of muscle artifact, it is sometimes difficult to tell if there are any seizure-type discharges on an EEG. It's common to see muscle artifact when people are chewing, when they are tense, or when they're moving their head or facial muscles a lot.

 

"Wickets" are normal variants of EEG wave forms. They do not signify any pathology. In the early days of EEG interpretation, people occasionally noticed certain wave forms that seemed to occur in several patients; and it was thought that they must represent some sort of pathology. Subsequently, it was determined that many such wave forms are not "abnormal" but rather are "normal variants." (There are at least half a dozen normal variants that decades ago were thought to possibly represent something pathological but have since been proven to be benign.)

 

Your EEG shows slower-than-normal wave forms periodic in the temporal lobe region of the brain (e.g. around the area above your ear). This can be due to several things. A structural lesion, such as a tumor, infection, or stroke, could cause such a pattern. It could also be seen in someone who has seizures (particularly when they're just coming out of a seizure). It can also be due to migraine headache. It's noteworthy that you have migraine headaches in that regard.

 

The EEG report says there is "no epileptiform activity." This means that there is no evidence anywhere in the recording of wave forms that would be indicative of a seizure disorder. A 24-hour EEG has very high sensitivity for picking up evidence of a seizure disorder. That your's showed no such evidence leads them to conclude that you do not have a seizure disorder and that your spells captured on EEG are not seizures.

 

It is not at all uncommon to see people have spells that can be confused for seizures. In fact, around 30 - 50% of people admitted to epilepsy monitoring units for evaluation for seizures are found to have spells that are, in fact, not seizures. These spells are often referred to as "pseudoseizures," though I personally do not like that term, because it often confuses patients and leads them to believe they have seizures (because "seizure" is part of the word "pseudoseizure") when they actually do not. I prefer the term "nonepileptic spell," (which specifically denotes that it is not a seizure). Nonepileptic spells are very often (i.e. usually) due to psychological stressors. This can be anything from current financial or family troubles to a history of abuse as a child. In fact, between a third and a half of patients with nonepileptic spells have a history of some form of abuse. (Note: That leaves at least 50% who have other psychological stressors.) Sometimes when people experience psychological stress, the subsconscious mind manifests it as a physical symptom (e.g. an apparent seizure or an apparent stroke, apparent blindness, etc.) because that is easier emotionally to deal with than the actual stressor. Often, patients aren't even aware of what the psychological stressor might be. (I have heard many say "But everything is going great in my life right now." When I delve deeper, I often find current or very distant sources of psychological stress that may be at the root of their spells.) Thus, when EEGs that capture such events show them not to be related to seizure, neurologists generally recommend that patients seek a psychologist (or the neurologist may make an appointment with one for the patient) to help identify and deal with whatever the underlying psychological stressor is.

Stroke Doc, Board Certified Physician
Category: Neurology
Satisfied Customers: 48
Experience: I am board-certified in Neurology and the subspecialty Vascular Neurology.
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