A 16-year-old boy is referred for a routine EEG following several syncopal-like events. His neurologic examination and awake background are normal. During drowsiness, you observe brief (<1 second) recurrent bursts of arciform, comb-like spikes at approximately 14 Hz, maximal over the posterior temporal regions and surface-positive in polarity. The bursts do not disrupt the background and are best appreciated on a referential montage. These are most accurately classified as

• Lateralized periodic discharges
• Polyspikes
• 14- and 6-Hz positive spikes
• Small sharp spikes
• Rhythmic mid-temporal theta of drowsiness
• Sleep spindles

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