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A Case with 6 per Second Positive Spike Discharges and Temporally Associated Clinical Manifestations

Although positive spike dysrhythmias, commonly in the 14 and 6 per second range, are reported as the most common (1) of all the forms of paroxysmal cerebral dysrhythmia, clinical seizures associated with this pattern have rarely been reported. The clinical correlation of this type of activity is usually non-convulsive in nature and the symptomatology is often referred to as "borderline atypical epilepsy or epileptic equivalents". The case we present has had clinical evidence of both general seizures or grand mal and minor attacks with what we might consider of a vegetative or autonomic variety. Positive spike activity was temporally associated with clinical seizures of this latter type. This patient was a twenty-three year old, white male, college student. He was originally seen in May of 1966 at the age of twenty. On May 3rd. he had awakened with intense general headache and had refused breakfast. Vomiting soon followed and then, the history indicates, he had had a generalized major motor seizure with tongue biting. General exhaustion followed the attack and about 3 or 4 hours later a further similar general seizure with unconsciousness ensued. Exploration of the past history revealed that at about eighteen months of age he had had several seizures during a single day. This had been associated with an ear infection and high fever. Otherwise, his past health had been good. There had been no further seizures until these current episodes. On initial examination the patient was found to be in a post-ictal confusional state with no focal signs. Later examinations after recovery revealed normal neurological findings. Routine studies in the hospital were normal for blood and urine. Skull films, spinal fluid pressure and cerebrospinal fluid analysis all proved to be within the range of normal. An electroencephalogram on May 4, 1966 revealed a moderate amount of paroxysmal slow activity" generalized in type, and with frequencies in the 4 7 per second range. In addition, during sleep, there were a few single small sharp spikes appearing from both hemispheres and without lateralized dominance. The patient's physician prescribed Dila ntin and phenobarbitral for him to take after leaving the hospital. At the time of his referral for an additional electroencephalogram on June 10, 1966, he reported that he had had no symptoms. His tracing on this occasion had reverted to normal. A few weeks later he discontinued anticonvulsant medication and had no further attacks until February 18, 1969. Then, during sleep, the history indicated that he had had a further major seizure followed by headache and vomiting. He was referred for a third time for an electroencephalogram. On this occasion, he informed the technician of his belief that he must have had several previous attacks of this nature during sleep judging from the way he had sometimes felt on awakening. During the course of their conversations the technician observed several episodes, lasting only a few seconds, when he suddenly stopped talking. His countenance reminded her of one who was attempting