Real Time Tele-Epilepsy Consultants - RTTC

Home
United States
Nashville, TN
Real Time Tele-Epilepsy Consultants - RTTC

Real Time Tele-Epilepsy Consultants (RTTC) is a physician-led organization delivering expert, high qu

04/08/2026

🧠 Case Summary:
A 64-year-old left-handed man experienced frequent focal sensorimotor seizures for about a year, described as electric shock–like sensations in the right thumb and forefinger, often triggered by hand movements.

🎥 Video-EEG Findings:
Seizures were reproducibly evoked by right-hand tapping, with ictal discharges localized to the left central and parietal regions — correlating with the sensorimotor symptoms.

🩻 Imaging:
MRI and CT revealed a metal splinter embedded in the left postcentral gyrus, near the hand k**b region, from a scalp injury sustained in infancy during a wartime air raid.

💊 Treatment & Outcome:
After multiple failed antiseizure medications, seizure control was finally achieved with levetiracetam and perampanel, maintaining near-complete remission for four years.

🔑 Key Point:
This case illustrates reflex epilepsy triggered by somatosensory input—in this instance, hand movement stimulating an epileptogenic zone within the contralateral perirolandic cortex.

📚 Reference: https://doi.org/10.1212/WNL.0000000000213704

🧠 Figure: Brain MRI (A, B, C) and Brain CT (D)

04/01/2026

⚙️ Remember electrodes have feelings, too! 🎧 Poor contact = poor data.

🧠 Why it matters: Loose electrodes can mimic focal slowing or create phantom spikes.

💡 Tech Tip: If one channel looks suspicious, check the electrode, not the patient. Even the best amplifier can’t fix a flaky connection.

03/25/2026

⚙️ When Asymmetry Speaks Volumes
Subtle amplitude asymmetry can reveal early hemispheric dysfunction – even before rhythmic or periodic activity appears.

🧠 Why it matters: Persistent voltage asymmetry, even without clear slowing, can indicate evolving structural or vascular pathology (e.g., acute ischemia, subdural hematoma, or focal edema). When amplitude reduction localizes consistently across montage types, it’s rarely benign.

💡 When evaluating asymmetry:
✔️ Confirm across multiple montages to rule out technical artifact.
✔️ Note whether asymmetry is persistent vs. state-dependent (e.g., appearing only during sleep or stimulation).
✔️ Document relative amplitude ratio (e.g., “right hemisphere voltage 40% lower than left”).
✔️ Correlate with reactivity – loss of reactivity on one side strengthens concern for focal dysfunction.

Even before periodic discharges appear, a consistent amplitude asymmetry trend may be the first sign that neuroimaging or clinical correlation is warranted.

03/18/2026

🎉Big announcement! 🎉

We’ve earned the Gold Seal of Approval from Joint Commission! This recognition reflects our ongoing commitment to delivering high-quality, safe, and reliable telehealth services for patients and healthcare partners across the country.

Huge thank you to our incredible team who helped make this possible! 👏

03/11/2026

⚙️ EEG Tech Tip: The Subtle Art of State Transitions
In continuous EEG (cEEG) monitoring, state changes are among the most meaningful indicators of cortical function and prognosis.

According to the ACNS guidelines, state changes are defined by the presence of at least two sustained background types, where:
✅ The background varies with alertness or stimulation (e.g., awake vs. unstimulated).
✅ Each background must persist ≥60 seconds to qualify as a true “state.”
✅ Stimulation (verbal, tactile, or auditory) should reliably transition the patient from the less-alert to the more-alert state.
✅ The more alert (stimulated) background is used as the “reported background” in your EEG report.
✅ Spontaneous state changes can occur and are equally meaningful.

🧠 Why it matters: Demonstrating reactivity and state change differentiates encephalopathy from deeper coma and provides valuable prognostic data, especially in post-cardiac arrest or sedated patients.

💡 Tech Tip: When documenting, label each background state clearly. Note whether transitions were stimulus-driven or spontaneous and the duration of each state (≥60 s). These distinctions are critical for standardized ACNS reporting and clinical interpretation.

03/04/2026

🧠 Case Summary: A 34-year-old right-handed woman was admitted to the epilepsy monitoring unit for evaluation of new events concerning for seizures. Her episodes consisted of:

• Repetitive eye blinking, behavioral arrest, lip smacking, and vocalizations
• Trace, nonrhythmic left-hand movements involving her cell phone — consistent with touch-screen automatisms
• Following each seizure, she experienced 10–20 minutes of retrograde amnesia, during which she sent identical text messages to the same three contacts: “What is your home address?”

🧩 EEG Findings:
• Right mid-temporal onset with increased beta activity at T4 with evolution to rhythmic delta spreading to the right anterior temporal and frontal regions
• Subsequent generalization to both hemispheres

📘 Takeaways:
• Touch-screen automatisms represent a novel form of gestural automatisms – seizure-related repetitive, purposeful actions linked to learned digital behaviors (e.g., texting, swiping, tapping).
• Mechanism: likely disinhibition of stored motor programs involving corticostriatal, frontal, parietal, and cerebellar circuits.
• Highlights how modern learned tasks can manifest in seizure semiology, emphasizing the need for careful contextual observation in EMU monitoring.

Learn more about this case here: https://www.neurology.org/doi/10.1212/WNL.0000000000213588

02/25/2026

The International League Against Epilepsy (ILAE) has released an update to the seizure classification system – enhancing clarity, clinical relevance, and consistency across healthcare settings.

This new framework builds on the 2017 model and is designed to be both practical and adaptable, whether in tertiary epilepsy centers or resource-limited environments.

🧠 The updated classification distinguishes four main seizure classes:
Focal
Generalized
Unknown whether focal or generalized
Unclassified

🔑 Key updates include:
Consciousness is now a classifier, defined by both awareness and responsiveness.
Observable vs. non-observable features help refine seizure semiology.
Expanded descriptors integrate temporal and somatotopic details, improving precision in diagnostic and surgical contexts.
Epileptic spasms receive renewed attention, underscoring the urgency of early identification and intervention – particularly in infants.

💡 EEG Tech Tip:
During seizure monitoring, document consciousness level, observable features, and sequence of events in your notes. These details are vital when applying the updated ILAE classification and can significantly influence syndrome diagnosis and treatment decisions.

Reference: Epilepsia, Volume: 66, Issue: 6, Pages: 1804-1823, First published: 23 April 2025, DOI: (10.1111/epi.18338)

02/18/2026

🧠 Case Study: Reflex Epilepsy — Seizures Triggered by a Geometric Pattern

Summary:
A 10-year-old boy with congenital cytomegalovirus infection, resulting in diffuse white matter injury and refractory epilepsy, presented with new staring spells triggered by viewing a specific geometric pattern — similar to mesh or window screen designs. During continuous video-EEG, exposure to this pattern immediately provoked:

💡Behavioral arrest and staring
💡Eyelid fluttering
💡Intermittent myoclonus of the head and shoulders

🧩 Findings:
Generalized polyspike–wave discharges (1–3 Hz) were observed, associated with atypical absence and myoclonic seizures.

📘 Takeaways:
Reflex epilepsies are seizures provoked by specific sensory stimuli: visual, auditory, or tactile.
Geometric reflex epilepsy is a rare visual subtype, triggered by repetitive geometric or patterned visuals (e.g., escalator steps, striped wallpaper, patterned clothing).
The mechanism involves cortical hyperexcitability in regions normally activated by visual pattern processing.
Ethosuximide was added, with marked clinical improvement.

📚 Reference: https://doi.org/10.1212/WNL.0000000000213664

Figure:
This image shows the fabric with the geometric pattern that triggered the patient's seizures.

02/11/2026

⚙️ EEG Tech Tip: Seizures Don’t Clock Out. Because let’s face it – they always happen right after you hit “End Recording.”

🧠 Why it matters: Monitoring beyond the expected window can catch critical activity.

💡 Tech Tip: When possible, extend a few minutes post-stimulation or post-awakening. The brain has its own schedule.

02/04/2026

🧠 Case Study: Clinical and Hallmarks of Epilepsy with Eyelid Myoclonia

Summary:
A 14-year-old boy with a history of daily eyelid myoclonia (EEM) with absences since age 3 presented for evaluation. He had one generalized tonic–clonic seizure at age 12 due to medication nonadherence. Previously failed valproate, ethosuximide, and lamotrigine. Neurologic exam and brain MRI were normal.

🧩 Findings:
Eye closure–induced 3–6 Hz irregular generalized spike or polyspike-wave discharges
Eye closure sensitivity
Photoparoxysmal response
Occipital spikes preceding generalized discharges

Together, these findings supported a diagnosis of Epilepsy with Eyelid Myoclonia (EEM), also known as Jeavons Syndrome – a rare generalized epilepsy, more common in girls (≈2:1), typically presenting between ages 2–14.

📚 Reference: https://doi.org/10.1212/WNL.0000000000214229

Figure:
Scalp EEG Showing Eye Closure–Induced Spiky Occipital α-like Activity (A) and Occipital Spikes (B), Generalized Photo-Paroxysmal Response at Multiple Frequencies (C), and Generalized Polyspike Waves in Non-REM Sleep (D)

01/28/2026

⚙️ Tech Tip: Precision
💪 Behind every clean trace is a tech with a steady hand, sharp eye, and way too many Q-tips.
🧠 Why it matters: The quality of EEG data starts long before interpretation.
💡 Tech Tip: Take pride in every setup, montage tweak, and electrode check – your precision drives every diagnosis.

01/21/2026

The Power of “Plus” Features

🚩 Periodic discharges with plus features (e.g., rhythmicity, fast activity, or superimposed sharp components) are red flags for ictal-interictal continuum (IIC) patterns.

🧠 Why it matters: A PLEDs+ or GPDs+ pattern carries a markedly higher seizure risk than periodic discharges alone.

💡 Tech Tip: Always note and tag “plus” modifiers in the description – e.g., LPDs+R (with rhythmicity) or GPDs+F (with fast activity). These details directly impact clinical decision-making and scoring systems like 2HELPS2B.

ACNS Standardized Critical Care EEG Terminology 2021: Reference Chart: Plus (+) Modifiers Link to Full Reference Chart:
🔗https://cdn-links.lww.com/permalink/jcnp/a/jcnp_2020_12_21_fong_00313_sdc099.pdf

Address

336 22nd Avenue North
Nashville, TN
37203

Telephone

+16153468182

Website

http://rttconsultants.com/

Alerts

Be the first to know and let us send you an email when Real Time Tele-Epilepsy Consultants - RTTC posts news and promotions. Your email address will not be used for any other purpose, and you can unsubscribe at any time.

Contact The Practice

Send a message to Real Time Tele-Epilepsy Consultants - RTTC:

Shortcuts

Want your practice to be the top-listed Clinic in Nashville?