title: Generalized periodic discharges: Pathophysiology and clinical considerations.
abstract: Generalized periodic discharges (GPDs) are commonly encountered in metabolic encephalopathy and cerebral hypoxia/ischemia. The clinical significance of this EEG pattern is indistinct, and it is unclear whether treatment with antiepileptic drugs is beneficial. In this study, we discuss potential pathophysiological mechanisms. Based on the literature, supplemented with simulations in a minimal computational model, we conclude that selective synaptic failure or neuronal damage of inhibitory interneurons, leading to disinhibition of excitatory pyramidal cells, presumably plays a critical role. Reversibility probably depends on the potential for functional recovery of these interneurons. Whether antiepileptic drugs are helpful for regaining function is unclear. This article is part of a Special Issue entitled "Status Epilepticus".
authors.affiliation: Department of Clinical Neurophysiology, MIRA, Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands; Dept of Neurology and Clinical Neurophysiology, Medisch Spectrum Twente, Enschede, The Netherlands. Electronic address: m.j.a.m.vanputten@utwente.nl.
authors.forename: Michel J A M
authors.initials: MJ
authors.lastname: van Putten
authors.affiliation: Department of Clinical Neurophysiology, MIRA, Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands; Department of Neurology, Rijnstate Ziekenhuis, Arnhem, The Netherlands. Electronic address: J.Hofmeijer@utwente.nl.
authors.forename: Jeannette
authors.initials: J
authors.lastname: Hofmeijer
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use*; D004569:Electroencephalography; D004827:Epilepsy / Q000188:drug therapy* / Q000503:physiopathology*; D006801:Humans; D020127:Recovery of Function; D013226:Status Epilepticus / Q000188:drug therapy* / Q000503:physiopathology*
chemical_list: D000927:Anticonvulsants
keywords: Feedforward inhibition; Generalized periodic discharges; Meanfield model; Status epilepticus; Synaptic failure