A patient was admitted due to super-refractory status epilepticus. After 20 days of treatment with levetiracetam, lacosamide, perampanel and the continuous infusion of midazolam and propofol to achieve electroencephalographic burst suppression, reduction of the anesthetics was started. Point of care spectral matrix (SM) and bispectral index monitoring revealed brief periods of decreased electroencephalogram (EEG) activity at delta frequencies (Fig. 1, white arrows, purple line = median of frequencies), unrelated to drug administration. On exporting the SM data to PDF format, paroxysmal repetition of these periods was observed (Fig. 2). Conventional EEG confirmed the presence of frontal intermittent rhythmic delta activity (FIRDA) (Fig. 3). The overlapped morphology of the waves displayed on the monitor BIS® monitor are shown in Figure 3 (bottom).

Fig. 1

Fig. 2

Fig. 3