The slow-wave component of the interictal epileptiform EEG discharges

The interictal epileptiform discharges (IEDs) consist of a fast component (FC; spike or sharp-wave) followed by a slow-wave component (SC). Our purpose was to assess the intra-individual variance, the diagnostic significance and the effect of sleep on the SC. Ninety-nine EEG recordings from 50 consecutive patients with IEDs were analysed. We measured the duration (ms) of the SC (SC-duration), while the amplitude of the SC was divided by the amplitude of the FC yielding a normalized value (SC/FC amplitude-ratio). Intra-individual, intra- and inter-recording coefficients of variation (CV) were calculated for the SC-duration and SC/FC amplitude-ratio. The correlation with the diagnosis, and the effect of sleep was analysed. The SC-duration and the SC/FC amplitude-ratio had low CV (<27%). The SC-duration was not correlated with the diagnosis. The SC/FC amplitude-ratio was significantly higher in the patients with generalized epilepsies as compared with the localization-related ones, and it was higher in the patients with idiopathic epilepsies as compared with the symptomatic ones. These predictors were independent. The SC/FC amplitude-ratio of the patients with idiopathic epilepsy increased significantly during sleep. We conclude that the SC-duration and SC/FC amplitude-ratio are stable parameters. The amplitude of the SC in relation to the fast component is larger in patients with generalized and idiopathic epilepsies, suggesting higher degree of cortical inhibition in these patients, possibly corresponding to specific protective mechanisms.