First of three consecutive ictal EEG epochs an ongoing autonomic seizure during wakefulness

The EEG shows an abrupt decrease of amplitude and slowing of alpha rhythm on the occipital leads of the left hemisphere, followed by sharp theta waves on temporal-occipital leads in the same region, evolving to high-voltage spike-wave activity at 3.5 Hz diffuse on the fronto-temporo-parietal leads of the left hemisphere. The seizure consisted of hyperventilation and shortness of breathing at its very onset, followed by bilateral piloerection associated with a feeling of cold and then hot with sweating, nausea, and diffuse weakness while the patient’s awareness remained completely preserved. The seizure occurred in a 53-year-old man affected with lesional mesial temporal lobe epilepsy hamartomatous. (Contributed by Dr. R Cremascoli.)