Subclinical rhythmic electrographic discharges of adult (SREDA) is a rare variant considered to be normal in EEG. It consists of sharp-contoured or sinusoidal waveforms in the theta frequency range (usually 5-7 Hz), occurring in a widespread distribution, often maximal over the parietotemporal regions. SREDA is usually bilateral but could be unilateral (atypical SREDA). Compared with true ictal activities, SREDA has little change in frequency, morphology, and distribution. It has been described in adults and is extremely rare in children/adolescents. There are only 5 cases published in children. We report a case of atypical SREDA in a child that may have occurred in wakefulness, non–rapid eye movement (NREM) sleep, and REM sleep. This finding was initially misdiagnosed as epilepsy. Inpatient video-EEG demonstrated that during periods of SREDA in quiet wakefulness the patient did not have any signs or symptoms with the SREDA pattern; SREDA abated whenever the patient was alerted or if he spontaneously initiated some activities. SREDA with same morphology was noted in NREM and REM sleep. The patient had no true epileptogenic abnormalities and hence antiepileptic medication was discontinued and stopped uneventfully. This case illustrates the importance of recognizing this rare variant, avoiding a misdiagnosis of epilepsy as it occurred in our case.

中文翻译：

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年轻青少年清醒时的非典型 SREDA、NREM 和 REM 睡眠：诊断挑战

成人亚临床节律性电图放电 (SREDA) 是一种罕见的变异，在 EEG 中被认为是正常的。它由θ频率范围（通常为 5-7 Hz）中的尖锐轮廓或正弦波形组成，分布广泛，通常在顶颞区最大。SREDA 通常是双侧的，但也可以是单侧的（非典型 SREDA）。与真正的发作活动相比，SREDA 在频率、形态和分布上几乎没有变化。它已在成人中被描述，在儿童/青少年中极为罕见。在儿童中仅发表了5例。我们报告了一个儿童非典型 SREDA 病例，该病例可能发生在清醒、非快速眼动 (NREM) 睡眠和 REM 睡眠中。这一发现最初被误诊为癫痫。住院视频脑电图显示，在安静清醒的 SREDA 期间，患者没有任何 SREDA 模式的体征或症状；每当患者收到警报或他自发地发起某些活动时，SREDA 就会减弱。在 NREM 和 REM 睡眠中注意到具有相同形态的 SREDA。患者没有真正的致癫痫异常，因此停用抗癫痫药物并顺利停止。这个案例说明了识别这种罕见变异的重要性，避免在我们的案例中发生癫痫的误诊。患者没有真正的致癫痫异常，因此停用抗癫痫药物并顺利停止。这个案例说明了识别这种罕见变异的重要性，避免在我们的案例中发生癫痫的误诊。患者没有真正的致癫痫异常，因此停用抗癫痫药物并顺利停止。这个案例说明了识别这种罕见变异的重要性，避免在我们的案例中发生癫痫的误诊。