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Ictal midline epileptiform discharges

R Amit¹, P K Crumrine

¹Department of Neurology, State University of New York, Stony Brook.

Clinical EEG (Electroencephalography)

|April 1, 1993

Summary

Midline epileptiform discharges on electroencephalogram (EEG) during seizures are uncommon, especially in adults. These midline discharges likely indicate seizure activity spreading from a different brain region, not the primary seizure focus.

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Area of Science:

Neurology
Clinical Neurophysiology

Background:

Epileptiform discharges from midline scalp EEG (Fz, Cz, Pz) are infrequent, primarily observed in pediatric populations and often linked to sleep-activated seizures.
Existing research on midline spikes predominantly focuses on interictal (between seizures) activity, with limited data on ictal (during seizures) events.

Observation:

This study presents 8 pediatric and adolescent patients (5 weeks to 17 years) exhibiting ictal midline discharges on scalp EEG.
Recorded seizure types included complex partial, simple sensory, and myoclonic seizures.
Ictal EEG patterns observed were spike and spike-and-slow wave complexes, rhythmic theta activity, background attenuation, and paroxysmal fast activity.

Findings:

The observed midline EEG discharges during seizures did not appear to originate from the midline structures themselves.
The variety of seizure types and EEG correlates suggest these midline discharges are secondary phenomena.

Implications:

Midline ictal discharges on EEG may not pinpoint the anatomical seizure origin.
These findings suggest that midline discharges likely represent the secondary propagation and summation of epileptogenic activity originating from a remote cortical area.

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