3 Hz Spike-and-Wave — SCE Neurology MCQ

Correct answer: C — Seizure-directed treatment trial with continued EEG and clinical monitoring

The best answer is “Seizure-directed treatment trial with continued EEG and clinical monitoring”. Relatively fast lateralised periodic discharges with plus features carry a substantial seizure association and lie on the ictal-interictal continuum; clinical correlation, antiseizure treatment trial and continued EEG are appropriate. “Report it as a benign normal variant requiring no further EEG” is less appropriate because lateralised periodic discharges are pathologic and seizure-associated “Diagnose psychogenic non-epileptic attacks from the absence of convulsions” is less appropriate because absence of motor activity does not exclude electrographic seizure activity “Conclude that the discharges prove irreversible cortical death” is less appropriate because periodic discharges reflect injured excitable cortex rather than proving brain death “Stop EEG because periodic discharges cannot evolve into seizures” is less appropriate because the pattern can evolve and continued monitoring helps determine response and seizure burden

Reference: ACNS standardized critical-care EEG terminology 2021. https://pubmed.ncbi.nlm.nih.gov/33475321/