EEG infraslow activity in absence and partial seizures

It is currently assumed that for recording of infraslow activity (ISA) DC-coupled amplifiers are required. This report will demonstrate that this may not be the case and presents some data about its potential clinical usefulness. Archived EEGs of 29 seizures from 6 children with absence attacks, accompanied by 3 Hz classical spike-wave discharges (SW), were compared with 20 partial seizures from 10 adult patients. The data from the children were acquired on a Bio-logic system, those from the adults on a Grass-Telefactor instrument. In the children the original 30-minute routine EEG was used while in the adults stored videomonitored data were excerpted to provide 20-minute segments which included the preictal, ictal and postictal state. All data were analyzed with the BESA software package. The seizures were evaluated separately on conventional filter settings, full band of 0.01-to the upper limit of the instrument, and 0.01-0.1 Hz (infraslow activity, ISA). Filter settings of 0.01-0.1 Hz provided a better assessment of ISA than when the full band was evaluated. Absence seizures showed bilateral essentially synchronous ISA with a negative positive sequence in the frontal areas and opposite polarity in the posterior head regions. In partial seizures when seizure onset was clearly lateralizeable from conventional frequency settings ISA corresponded to that hemisphere, but the electrode position could be displaced to a neighboring one from the one which was maximally involved on conventional settings. Topographic analysis showed two types of ISA: one with focal spread only and the other where there was in addition an element of synchrony especially in the frontal areas. It is concluded that ISA can be recovered from conventional EEG recordings and may be helpful not only in determining the area(s) of seizure onset but can also differentiate truly focal seizures from those where an additional generalized seizure tendency is present. This is likely to be important when epilepsy surgery is performed in absence of a demonstrable structural lesion.