HighlightsDelta brushes have been inconsistently described over the last five decades.Their characteristics vary according to gestational age and vigilance state.Delta brushes can be spontaneous or elicited by peripheral stimuli.Different delta brush abnormalities are a marker of specific pathologies.

Summary Purpose Although differences in illness perceptions between neurologists and patients with epilepsy or psychogenic nonepileptic seizures (PNES) are likely to be clinically relevant, this is the first study to attempt a direct comparison. In addition, this study compares the illness perceptions of patients with epilepsy with those of patients with PNES. Methods Thirty‐four patients with epilepsy, 40 patients with PNES, and 45 neurologists were recruited. All patient participants completed versions of the illness perception questionnaire revised (IPQ‐R) adapted for epileptic or nonepileptic seizure disorders, single‐item symptom attribution question (SAQ), Hospital Anxiety and Depression Scale (HADS), Quality of Life in Epilepsy‐31 (QOLIE‐31), and Liverpool Seizure Severity Scale (LSSS). Participating neurologists completed two versions of the IPQ‐R and two SAQs for epileptic and nonepileptic seizure disorders. Key Findings Differences in illness perceptions between patients with epilepsy and patients with PNES were minor compared to those between patients with either seizure disorder and neurologists. Neurologists considered both seizure disorders more treatable and more amenable to personal control than did the patients themselves. Neurologists had much more polarized views of the etiology of both conditions; whereas patients mostly considered the causes of their seizure disorders as partially “physical” and partially “psychological,” neurologists perceived epilepsy as an essentially “physical” and PNES as a clearly “psychological” problem. Significance There are considerable differences between the illness perceptions of patients with seizure disorders and their doctors, which could represent barriers to successful clinical management. In particular, a discrepancy between neurologists' and patients' beliefs about the personal control that patients may be able to exert over PNES could contribute to the confusion or anger some patients report after the diagnosis has been explained to them. Furthermore, patients' endorsement of “physical” causes for PNES may reflect an unrealistic faith in the effectiveness of “physical” treatments and could be a cause of tension in patients' relationship with their doctor, for instance when the neurologist attempts to withdraw antiepileptic drug treatment or refers patients for psychological interventions.

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Electroencephalographic recordings from the developing human brain are characterized by spontaneous neuronal bursts, the most common of which is the delta brush. Although similar events in animal models are known to occur in areas of immature cortex and drive their development, their origin in humans has not yet been identified. Here, we use simultaneous EEG-fMRI to localise the source of delta brush events in 10 preterm infants aged 32–36 postmenstrual weeks. The most frequent patterns were left and right posterior-temporal delta brushes which were associated in the left hemisphere with ipsilateral BOLD activation in the insula only; and in the right hemisphere in both the insular and temporal cortices. This direct measure of neural and hemodynamic activity shows that the insula, one of the most densely connected hubs in the developing cortex, is a major source of the transient bursting events that are critical for brain maturation.

The somatosensory system has a hierarchical organization. Information processing increases in complexity from the contralateral primary sensory cortex to bilateral association cortices and this is represented by a sequence of somatosensory-evoked potentials recorded with scalp electroencephalographies. The mammalian somatosensory system matures over the early postnatal period in a rostro-caudal progression, but little is known about the development of hierarchical information processing in the human infant brain. To investigate the normal human development of the somatosensory hierarchy, we recorded potentials evoked by mechanical stimulation of hands and feet in 34 infants between 34 and 42 weeks corrected gestational age, with median postnatal age of 3 days. We show that the shortest latency potential was evoked for both hands and feet at all ages with a contralateral somatotopic source in the primary somatosensory cortex (SI). However, the longer latency responses, localized in SI and beyond, matured with age. They gradually emerged for the foot and, although always present for the hand, showed a shift from purely contralateral to bilateral hemispheric activation. These results demonstrate the rostro-caudal development of human somatosensory hierarchy and suggest that the development of its higher tiers is complete only just before the time of normal birth.