A six-hertz spike and wave pattern has been reliably described as a benign rhythm of reactivity and drowsiness and occurs in 2.5% of adolescents and adults. Seizures are more commonly derived from a higher frequency and larger amplitude pattern on electroencephalography. This is a case of a six-hertz spike and wave pattern associated withgeneralized tonic-clonic seizures from a possible focus of cortical dysplasia. Case Description: A nineteen-year-old male presented to the hospital after his

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... cond witnessed seizure. Seizure semiology is generalized tonic-clonic in nature and unprovoked. His neurologic examination was non-focal. His general examination and basic labs including an infectious work-up and full drug screen were negative. He was admitted for observation and found to have a sixhertz generalized spike wave pattern on his electroencephalogram. A contrasted MRI of the brain was performed and revealed a right frontal heterogeneous lesion adjacent to the anterior horn of the lateral ventricle. He was subsequently placed on an anti-epileptic medication and reports being seizure free at six-month follow-up. Discussion: This case illustrates a patient where a six-hertz spike wave pattern is correlated with seizures and cortical dysplasia. Historically, a six-hertz spike wave pattern has been coined "phantom spike and wave" as it has been correlated with reactivity and known to be a rhythm of unknown significance. However, in the correct clinical circumstance, further investigation of this electroencephalographic pattern may be warranted in order to ensure appropriate therapy and management. In this report we discuss a case of epileptic seizures associated with a benign six-hertz spike and wave elect roencephalographic pattern originating from focal cortical dysplasia. A phantom six-hertz spike and wave pattern has not been reported in literature in relation to cortical dysplasia and epilepsy.