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Epileptic Disorders

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A triad of infantile spasms, nystagmus and a focal tonic seizure Volume 20, issue 4, August 2018

Figure 1

(A) Interictal background activity showing moderate-to-high voltage, asynchronous, slow-wave activity, predominant in the right hemisphere, with occasional sharp waves in the right frontal region (bipolar, longitudinal montage). (B) Onset of ictal activity showing the interruption of the background slow-wave activity by an asymmetric electrodecrement, more prominent on the right (left panel: bipolar longitudinal montage) and in the anterior regions (right panel: bipolar, transverse montage), preceded by slow waves in the frontal regions. (C) Ictal activity progresses to a rhythmic slow-wave pattern in the fronto-central regions (right panel: bipolar, transverse montage), more prominent on the right (left panel: bipolar longitudinal montage), leading into a brief polyspike pattern that correlates with a focal tonic seizure involving the right upper extremity (see video). (D) The end of the ictal event showing a polyspike and electrodecrement pattern, more prominent on the right side (left panel: longitudinal montage) and in the frontal regions (right panel: bipolar, transverse montage).