Generalized paroxysmal fast activity: Electroencephalographic and clinical features

Brenner, Richard P.; Atkinson, Ruth

doi:10.1002/ana.410110412

Cited by 64 publications

(43 citation statements)

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“…GPFA also can be either an ictal or interictal phenomenon. When GPFA occurs in sleep, a clinical correlate is often absent or unrecognized (1,2). In addition, GPFA may be confused with drug-induced beta activity, muscle artifact, or sleep spindles (2).…”

Section: Discussionmentioning

confidence: 99%

“…Generalized paroxysmal fast activity (GPFA, >13 Hz) and its clinical manifestations (typically a brief tonic seizure) have been extensively described in the literature (1)(2)(3). Considerable literature also focused on the electroencephalographic and clinical features of generalized slow spike-and-wave (GSS&W, <3 Hz) complexes (atypical absence seizures) (4)(5)(6).…”

mentioning

confidence: 99%

“…A distinct electroclinical pattern of GPFA immediately followed by GSS&W, however, has not been well described. Only passing references to this phenomenon have been made (2,7), and these observations were made in the pre-video-EEG monitoring era.…”

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confidence: 99%

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Tonic–Absence Seizures: An Underrecognized Seizure Type

Shih

Hirsch

2003

Epilepsia

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Summary: Purpose:The individual electroclinical patternstonic seizures with generalized paroxysmal fast activity (GPFA, activity >13 Hz), and absence seizures with generalized slow spike-and-wave activity (GSS&W, <3 Hz)-have been extensively described in the literature. However, only passing reference was made to the pattern of GPFA followed by GSS&W. In addition, these descriptions were formulated in the pre-EMU (Epilepsy Monitoring Unit) era, without benefit of video/clinical correlation. We now characterize this underrecognized seizure type.Methods: We retrospectively reviewed the data from eight patients with seizures that demonstrated this stereotyped EEG and clinical pattern.Results: We identified eight patients (six female patients; age 6-29 years; age at seizure onset, neonate to 10 years) who were evaluated at the Columbia University Epilepsy Monitoring Units between 1993 and 2002. All eight had an International League Against Epilepsy (ILAE) diagnosis of symptomatic generalized epilepsy, with six of eight manifesting multiple seizure types, six of eight with mild static encephalopathy, and two with normal cognition. A total of 29 seizures of this pattern was recorded; 26 of 29 seizures demonstrated GPFA (frequency between 14 and 30 Hz, lasting 2-8 s) followed by GSS&W (frequency range between 1 and 2 Hz, lasting 3-50 s). The predominant clinical correlate was bilateral tonic activity followed by a period of inattentiveness. In general, these seizures were differentiated from the patient's typical tonic seizures by this protracted period of impaired attentiveness.Conclusions: We describe a heretofore underrecognized and poorly characterized seizure type in patients with symptomatic generalized epilepsy, which we have termed tonic-absence seizures. Clinically and electrographically, this consists of a tonic seizure with GPFA followed by an absence seizure with GSS&W. Key Words: Tonic seizures-Absence seizuresVideo-EEG monitoring-Generalized epilepsy-Slow spikeand-wave-Tonic-absence.Generalized paroxysmal fast activity (GPFA, >13 Hz) and its clinical manifestations (typically a brief tonic seizure) have been extensively described in the literature (1-3). Considerable literature also focused on the electroencephalographic and clinical features of generalized slow spike-and-wave (GSS&W, <3 Hz) complexes (atypical absence seizures) (4-6). A distinct electroclinical pattern of GPFA immediately followed by GSS&W, however, has not been well described. Only passing references to this phenomenon have been made (2,7), and these observations were made in the pre-video-EEG monitoring era.We selected patients who were monitored by continuous video-EEG and who demonstrated the EEG and clinical pattern of GPFA with tonic posturing immediately preceded or followed by GSS&W with a clinical absence seizure. We then reviewed the video-EEG and clinical characteristics of this patient population. METHODSEleven patients had EEG recordings that demonstrated at least one example of a sustained period of GPFA that was either pre...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Tonic–Absence Seizures: An Underrecognized Seizure Type

Shih

Hirsch

2003

Epilepsia

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“…22). Also common in Lennox Gastaut syndrome patients is the presence of bursts of fast activity during slow wave sleep (Gibbs and Gibbs, 1952;Brenner and Atkinson, 1982;Beaumanoir and Dravet, 1992;Markand, 2003;Fig. 23).…”

Section: Lennox Gastaut Syndrome (Atypical Absence Tonic and Atonic mentioning

confidence: 97%

The EEG in Selected Generalized Seizures

Hrachovy¹,

Frost²

2006

Journal of Clinical Neurophysiology

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“…PFA, especially generalized events, have historically been associated with severe epileptic encephalopathy, such as infantile spasms and the Lennox-Gastaut syndrome, and PFA is most often observed during non-REM sleep (Brenner and Atkinson 1982; Gastaut et al 1966; Green and Wilson 1961; Kobayashi et al 2004; Lombroso and Erba 1969). …”

Section: Introductionmentioning

confidence: 99%

Paroxysmal fast activity: An interictal scalp EEG marker of epileptogenesis in children

Koh

Sankar

et al. 2008

Epilepsy Research

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Purpose High frequency oscillations (>100 Hz) have been proposed as localized markers of epileptic networks, but require intracranial electroencephographic (EEG) recordings. This study explored if β- and γ- frequency paroxysmal fast activity (PFA), recorded interictally during non-REM sleep, could be used as a scalp EEG marker of epileptogenesis in children. Methods The presence and scalp location of PFA was visually identified in 681 patients with overnight video-EEG (age 0 to 18 years), and compared with ictal onset sites. The clinical features of patients with PFA were compared with patients without PFA along with evidence of PFA evolution in 35 patients who had multiple video-EEG records. Results PFA was present in 16% of all patients and in 28% of those with seizures. PFA was more frequently observed in EEGs from patients 3 years of age or younger (>40%), and children with infantile spasms (85%). When present, PFA predicted if the patient had epilepsy with 97% accuracy, and was not found in individuals with non-epileptic events. PFA localized with EEG-ictal onset sites with 91% sensitivity and 82% accuracy. Ictal scalp EEG events began with β- and γ-frequencies in 80% of patients with PFA, and they had increased seizure frequencies compared with non-PFA cases. In patients with multiple video-EEG studies, PFA showed progression over increased numbers of electrodes in 74%, improvement in 15%, and remained unchanged in 12% and correlated with seizure evolution. PFA was not associated with other seizure types, anatomic location, type of antiepileptic drug, etiology, or histopathology. Conclusions While relatively infrequent, interictal PFA was specific in identifying younger children with epilepsy, co-localized with the ictal onset sites on scalp video-EEG, and progressed and correlated with seizure severity. We propose that PFA is a scalp EEG marker of epileptic networks with the advantage of being recorded non-invasively during interictal non-REM sleep.

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Generalized paroxysmal fast activity: Electroencephalographic and clinical features

Cited by 64 publications

References 12 publications

Tonic–Absence Seizures: An Underrecognized Seizure Type

Tonic–Absence Seizures: An Underrecognized Seizure Type

The EEG in Selected Generalized Seizures

Paroxysmal fast activity: An interictal scalp EEG marker of epileptogenesis in children

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