Rhythmic high-amplitude delta with superimposed spikes (RHADS): a treatment dilemma

Pathognomonic EEG patterns have been described in genetic conditions such as Angelman and Rett syndromes. EEG patterns along the ictal-interictal continuum have been increasingly recognized with the greater availability of continuous EEG monitoring; however, treatment decisions may be difficult with unpredictable clinical implications. Rhythmic High-Amplitude Delta Activity with Superimposed (Poly) Spikes (RHADS) has been described as a particular EEG pattern in POLG1 Alpers Syndrome. The balance between treating subclinical seizures and managing encephalopathy in these patients is challenging.