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Description of a peculiar alternating ictal electroclinical pattern in a young boy with a novel SPATA5 mutation Volume 22, numéro 5, October 2020

The ictal EEG shows the interruption of interictal slow and paroxysmal activity and the appearance of clusters of short sequences of low-voltage fast activity initially on the posterior regions of the right hemisphere, then moving from one hemisphere to the other in almost a periodical and alternating trend. At first, fast activity involves the right hemisphere and is more evident on the posterior areas after a slow movement of the eyes towards the right. The fast activity is then bilateral, superimposed on a biphasic slow wave, and followed by an electrodecrement, with the occurrence of a subtle spasm. Lastly, fast activity superimposed on the ascending side of a diphasic slow wave involves the centro anterior regions of the left hemisphere concurrently with an upward gaze movement towards the left. At four years of age, the ocular movements still appeared in clusters but assumed the clinical characteristics of vertical nystagmus. The ictal EEG was characterized by a sequence of bilateral and synchronous fast activity.

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