Real Time Tele-Epilepsy Consultants - RTTC

10/14/2026

📊 Filters can create-or hide-problems.

💡 Be mindful of:
🔹 High-frequency filter too low → hides spikes
🔹 Low-frequency filter too high → distorts slow waves
🔹 Notch filter → may mask real activity

⚠️ Golden Rule: Always review suspicious activity with default/standard filter settings and modify accordingly

👇 Have filters ever fooled your interpretation?

10/08/2026

📚 Case Study: When Flushing Is a Seizure

A 73-year-old man presented with recurrent episodes of abrupt bilateral forehead flushing, sometimes accompanied by staring, dry cough, and dyspnea. An initial workup for systemic causes was negative. Over the next two months, he developed brief episodes of impaired awareness with right-sided facial and arm jerks, along with cognitive decline and eventual convulsive seizures.

The jerking episodes were identified as faciobrachial dystonic seizures, and the flushing episodes—initially occurring in isolation—were recognized as an autonomic seizure manifestation. showed left temporal dysfunction, and MRI revealed subtle medial temporal changes. Antibody testing confirmed LGI1-antibody encephalitis.
Notably, all seizure types were unresponsive to antiseizure medications but resolved with immunotherapy.

💡 Key takeaway: Autonomic symptoms like flushing may be early seizure manifestations, not just systemic phenomena.

💡 Bottom line: When the presentation doesn’t fit, think autoimmune—early recognition and treatment can be critical for preventing cognitive decline.

📚 Reference: https://doi.org/10.1212/WNL.0000000000214700

09/30/2026

📊 Don’t skip reactivity testing—it tells you more than you think.

💡 Assess how the EEG responds to:
🔹 Verbal stimulation
🔹 Painful stimulation
🔹 Eye opening/closing

⚠️ Red Flag:
A lack of reactivity in an encephalopathic patient can suggest more severe dysfunction or even poor prognosis in certain settings.

👇 Do you routinely test reactivity, or rely on baseline observation?

Image: This image shows a good anterior-posterior gradient, eye blinks, and PDR emergence with eye closure and recession with eye opening. There is also some myogenic artifact over the frontal regions. Learn more: https://www.learningeeg.com/atlas?chapter=normal-awake

09/24/2026

The First 2 Seconds Matter Most.

If you’re not looking at the onset, you’re missing the story. Many discharges look “generalized” but started somewhere very specific.

👉 Especially in:
• Frontal lobe seizures
• Rapid secondary generalization
• Deep or mesial sources

👉 What to focus on:
• The first 100–200 ms
• Subtle asymmetry in amplitude
• Slight timing delays between hemispheres
• Early phase reversals

💡 Key insight:
• By the time a pattern looks generalized, the localizing information may already be gone.

09/17/2026

Join Nabil Azar, MD next week to learn the differential diagnosis of nonepileptic seizures and the peri-ictal and ictal semiology of epileptic vs nonepileptic seizures. Register now:

Access free continuing education for EEG technologists. Live webinars, on-demand courses, and CEU credits. Register for EEG U and ELEVATE U programs today.

09/16/2026

In the ICU, artifact is often the loudest signal in the room—and sometimes the most misleading. Device-related and physiologic artifact can closely mimic epileptiform activity, especially:
• IV pumps / infusion devices → rhythmic, repetitive discharges that can resemble periodic patterns
• Ventilators / respiratory cycles → slow, rhythmic deflections time-locked to breathing
• ECG contamination → sharp transients that may be mistaken for spikes
👉 These patterns can be particularly deceptive in critically ill patients, where the clinical threshold for seizure concern is already high.

👉 Always correlate with:
• Raw EEG signal (not just compressed trends or automated detections)
• Physiologic rhythms (heart rate, respiratory rate, ventilator timing)
• Video + bedside activity when available
• Clinical timing (Was a pump cycling? Was the patient being repositioned?)

💡 Key insight:
• True epileptiform activity typically demonstrates evolution—in frequency, amplitude, or spatial distribution.
• Most ICU artifact is time-locked, repetitive, and non-evolving once you recognize the source.

09/09/2026

Check out this excellent educational opportunity featuring RTTC's own Nabil Azar, MD!

Learning Objectives:
1. The differential diagnosis of nonepileptic seizures
2. The peri-ictal and ictal semiology of epileptic vs nonepileptic seizures
3. The discriminative features of epileptic vs nonepileptic seizures

Register now:

Access free continuing education for EEG technologists. Live webinars, on-demand courses, and CEU credits. Register for EEG U and ELEVATE U programs today.

09/07/2026

Time to kick back and relax! Happy Labor Day!

09/03/2026

The ketogenic diet has been used to reduce seizures since the 1920s. The mechanism by which the seizures are regulated is poorly understood. Both the low sugar component and high fat component uniquely alter the ‘excitability’ of the brain, thereby reducing the tendency to generate seizures.

The keto diet has proven effective over time to help epilepsy. About 40% to 50% of children who start the keto diet have 50% fewer seizures. And roughly 10% to 20% of children achieve more than 90% reduction in seizures.

The ketogenic diet is high in fat, adequate in protein, and very low in carbohydrates (carbs). Learn More: https://www.epilepsy.com/treatment/dietary-therapies/ketogenic-diet

08/26/2026

Real Time Tele-Epilepsy Consultants (RTTC) is a physician-led organization focused on delivering expert, high quality EEG interpretation and customizable tele-epilepsy consultation services via telehealth to hospitals, outpatient facilities and ambulatory EEG companies, regardless of geographical location.

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