Is this an abonormal EEG?

[Auggie]

My son turned 4 years old on April 3.  About a week before his birthday, he woke in the middle of the night complaining of a stomach ache.  He said he felt like he had to vomit but never did.  He was up for about 3 hours that night.  The next morning, he still did not feel well and would not eat anything and only drink water.  About 10:30 am, he said he needed to vomit. He did -only dry heaves, but during this process became limp in my arms and though his eyes remained open, he would not focus on anything and would not respond to me.  When his lips turned blue, I thought he was choking and called 911.  The lifesquad came within minutes, and by that time he was breathing but sleeping and not wanting to be awakened.  HE was taken to our Children's Hospital where he was treated with IV fluids and given an EKG (normal).  The ER physician examined him and told us it was most likely a vasal vagal (spelling? ) response due to the exeretion of vomiting.  We explained that though this had never happened before, he has had what our peditrician calls "sleep walking" incidents ( 4 over a 12 month period) where he cries uncontrollably (always early morning), wets the bed (which he NEVER does other than these occasions), his eyes are open but unfocused on us. This may last for a minute or two, then he goes back into a sound sleep for 3-4 hours, sleeping much longer than he normally does. These events always happen when he's over-tired or over-stimulated. We've asked if these were seizures (there's never been twitching or movement),but our doctor thinks he's actually sleeping during all of this.  On to the EEG...as a result of the ER visit, our doctor ordered an EEG.  It was done on his actual 4 yr birthday.  The results were as follows: "The posterior background rhythm with the patient  awake and eyes closed was a moderate voltage -6-7 Hz.  No drowsiness was seen.  NO sleep was obtained. No interhemisphereic voltage asymmetries were noted. No interhemispheric frequency asymmetries were noted.  No epileptiform discharges were noted.  Photic stimulation was performed and failed to activate any abonormalities.  Hyperventilation wsa not performed.  Excessive muscle and movement artifact was noted thruout the tracing.  Heart rate and rhythm looked normal during tracing."  The first Neurologist who read it said it was "an abonormal awake tracing for age.  Mild slowing of the background rhythm was noted."  Our Pediatrician had a 2nd Neurol. review it who said that the EEG was not abnormal and that it was an EEG of someone who was drowsy.  (The test was done early morning-patient had to be awakened to go to test).  Our appointment with the Neurologist isn't until July--we can't get in earlier because they don't feel our son has a critical problem.  However, we are concerned.  What do you think of these EEG results in conjunction with the patient's history?  Thank you in advance for your time and help!

[CCF Neuro[P]-M.D.-RPS]

Dear Auggie:

I am very sorry to hear about your worries.  From the description of the EEG, it sounds normal to me.  I read many EEGs of children every day.  The posterior background rhythm in a child age 4 is anywhere from 6 to 8 Hertz.  So your son's is normal.  Some children do not sleep, at the Cleveland Clinic, our definition of sleep is stage II.  Drowiness is stage I.  We would like children to sleep as sleep enhances the detection of epileptiform discharges.  I would definitely not (NOT) agree with the first neurologist who read the EEG study.  Unfortunately, he did not sleep but what was present on the EEG is not abnormal.  I think your son likely has a sleep disorder, although not worrisome.  He sleep walks.  I would agree with the ED doctor that his event was likely a vagal response from the vomiting.  

Sincerely,

CCF Neuro MD