Real Time Tele-Epilepsy Consultants - RTTC

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Real Time Tele-Epilepsy Consultants - RTTC

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

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

01/08/2026

How can we partner in 2023 to complete your EEG interpretation services?

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.

Follow us here and stay connected!

01/01/2026

Wishing you peace, joy, and a bright New Year! Cheers to 2026!

12/24/2025

Happy Holidays from RTTC!

12/18/2025

The 2HELPS2B is a practical risk score used to estimate the likelihood of electrographic seizures in hospitalized patients undergoing continuous EEG (cEEG) monitoring. Each letter stands for a key EEG or clinical feature:

H – Presence of periodic discharges with plus features
E – Presence of epileptiform discharges
L – Lateralized rhythmic or periodic patterns
P – Prior seizure or clinical suspicion
S – Brief potentially ictal rhythmic discharges (BIRDs)
2B – Background showing burst suppression or attenuation (worth two points)

🧠 Why it matters:
This tool helps identify patients at higher risk for seizures, guiding when to extend EEG monitoring or escalate treatment.

💡 EEG Tech Tip:
Always describe EEG background, rhythmic/periodic patterns, and “plus” features clearly in your reports. These details directly impact a patient’s 2HELPS2B score and can influence clinical management decisions like anti-seizure medication use or continued monitoring.

12/10/2025

Recognizing Brief Ictal Rhythmic Discharges (BIRDs): 🐦BIRDs are brief (

12/03/2025

In neurodiagnostics, we know that every small pathway tells a big story. The 12 cranial nerves are responsible for everything from smelling a morning coffee ☕ to controlling eye movement 👀 and maintaining balance 🦶.

Each nerve has a unique role and when one isn’t functioning properly, the impact can be profound. That’s why detailed EEGs and neurological assessments are so critical in diagnosing and managing disorders that affect these pathways. 🧠

💡 EEG Tech Tip: When recording, always make note of cranial nerve–related findings – for example, facial asymmetry, ptosis, or abnormal eye movement. Subtle observations like these can provide valuable context when correlating EEG changes with clinical presentation.

Address

336 22nd Avenue North
Nashville, TN
37203

Telephone

+16153468182

Website

http://rttconsultants.com/

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