AI Summary
A 14-year-old girl was diagnosed with nonepileptic events after a diagnostic evaluation for recurrent abdominal pain. However, her long-term EEG recording revealed normal developmental variants that should be recognized to avoid misdiagnosis.
A 14-year-old girl presented to the epilepsy monitoring unit for diagnostic evaluation of recurrent episodic abdominal pain. During the admission, multiple typical episodes lacked ictal correlate, and she was diagnosed with nonepileptic events. However, her long-term EEG recording revealed several transient findings in wakefulness and sleep exemplifying normal developmental variants in the awake (Figure 1) and asleep (Figure 2) EEG. Posterior slow waves of youth, 14 and 6 Hz positive spikes, and alpha squeak are rare before 2 years, and only alpha squeak persists after adolescence.1,2 Lambda waves and positive occipital sharp transients of sleep do not occur younger than 1 year and are more common in later childhood through adulthood.1,2 Rhythmic midtemporal theta of drowsiness occurs from adolescence through adulthood.2 We show examples of these variants in 3 separate montages, highlighting the montage(s) in which each is best appreciated.1,2 Proper recognition of these age-appropriate normal EEG variants is key to avoid overinterpretation and misdiagnosis.2