No Sleep Spindles

[KCV]

Is there anyone on the forum who can help interpret an EEG? This is what I received (it's been translated into English):

At rest, dual-sided occipital irregular high-amplitude theta activity every 4-5/sec., which reached temporal and frontal, blinking not feasible. A clear numb area in the frontal leads.

The sleep stages according to Rechtschaffen and Kales cannot be clearly distinguished from each other; however, there are clearly no sleep spindles.

During the falling asleep phase, primarily hypnagogic theta groups are observed, thereafter sporadic sharp and spike waves with varying localization.

A bioelectrical status during sleep cannot be proven.

Conclusion:

Medium-grade general changes, no focal findings, discrete signs of increased cerebral excitability during sleep without side localization. Disturbed sleep architecture. No bioelectrical status during sleep.

This is for a four-year-old child. I'm very worried. Does this mean he is not dreaming? What does the absence of sleep spindles mean? I know it's hard to say when you haven't seen the eeg itself, but I'd just like to know the implications here. Obviously, we are going to continue with his epilepsy treatment (ketogenic diet).

Thanks for any enlightenment anyone can provide.

[CCF-Neuro-M.D.-SH]

First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
   The EEG report is worded in a confusing manner and it is difficult to interpret without seeing the EEG itself, but I can point out a few major findings.  They are reporting abnormal sleep architecture and sharp waves and spikes in various locations during sleep.  This means that the patient is likely not recieving the restorative sleep that we need to maintain our memories and cognitive skills and along with the epileptic activity (spikes etc) can lead to cognitive regression, behavioral problems, fatigue etc.  The report seems ambivalent on the classification of elctrical status epilepticus in sleep (ESES), it states it cannot be proven and that there is none (but ther is hyper exicitability)-I do not think they made up their mind properly.  If there is ESES (as seen in certain epileptic conditions including Landau Klefner and Lenox-Gastaut syndrome, then the ketogenic diet along with steroids and possibly klonipin are of use.  Sleep spindles do not indicate dreaming, they indicate stage II sleep.  Dreaming occurs during REM (rapid eye movement) sleep that is characterized by rapid oblique eye movements and loss of muscle activity.  There was no mention of REM sleep in the report (presence or absence).
I would suggest that you get a repeat overnight EEG (at least 24 hours) at a major academic institution given the gravity of these findings.
I hope this has been helpful.

[KCV]

I just wanted to add that I think the references to "no bioelectrical status" means no hypsarrithmia.