title: Networks underlying paroxysmal fast activity and slow spike and wave in Lennox-Gastaut syndrome.
abstract: OBJECTIVE
  To use EEG-fMRI to determine which structures are critically involved in the generation of paroxysmal fast activity (PFA) and slow spike and wave (SSW) (1.5-2.5 Hz), the characteristic interictal discharges of Lennox-Gastaut syndrome (LGS).
  
  
  METHODS
  We studied 13 well-characterized patients with LGS using structural imaging and EEG-fMRI at 3 tesla. Ten patients had cortical structural abnormalities. PFA and SSW were considered as separate events in the fMRI analysis.
  
  
  RESULTS
  Simultaneous with fMRI, PFA was recorded in 6 patients and SSW in 9 (in 2, both were recorded). PFA events showed almost uniform increases in blood oxygen level-dependent (BOLD) signal in "association" cortical areas, as well as brainstem, basal ganglia, and thalamus. SSW showed a different pattern of BOLD signal change with many areas of decreased BOLD signal, mostly in primary cortical areas. Two patients with prior callosotomy had lateralized as well as generalized PFA. The lateralized PFA was associated with a hemispheric version of the PFA pattern we report here.
  
  
  CONCLUSIONS
  PFA is associated with activity in a diffuse network that includes association cortices as well as an unusual pattern of simultaneous activation of subcortical structures (brainstem, thalamus, and basal ganglia). By comparison, the SSW pattern is quite different, with cortical and subcortical activations and deactivations. Regardless of etiology, it appears that 2 key, but distinct, patterns of diffuse brain network involvement contribute to the defining electrophysiologic features of LGS.
authors.affiliation: Brain Research Institute, Department of Medicine, University of Melbourne, Australia.
authors.forename: Neelan
authors.initials: N
authors.lastname: Pillay
authors.forename: John S
authors.initials: JS
authors.lastname: Archer
authors.forename: Radwa A B
authors.initials: RA
authors.lastname: Badawy
authors.forename: Danny F
authors.initials: DF
authors.lastname: Flanagan
authors.forename: Samuel F
authors.initials: SF
authors.lastname: Berkovic
authors.forename: Graeme
authors.initials: G
authors.lastname: Jackson
mesh_terms: D000328:Adult; D001921:Brain / Q000503:physiopathology*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008607:Intellectual Disability / Q000503:physiopathology*; D065768:Lennox Gastaut Syndrome; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012815:Signal Processing, Computer-Assisted; D013036:Spasms, Infantile / Q000503:physiopathology*