title: Cessation of gamma activity in the dorsomedial nucleus associated with loss of consciousness during focal seizures.
abstract: BACKGROUND
  Impaired consciousness during seizures may be mediated by ictal propagation to the thalamus. Functions of individual thalamic nuclei with respect to consciousness, however, are largely unknown. The dorsomedial (DM) nucleus of the thalamus likely plays a role in arousal and cognition. We propose that alterations of firing patterns within the DM nucleus contribute to impaired arousal during focal seizures.
  
  
  METHODS
  Electroencephalograph data were collected from electrodes within the left DM thalamus and midcingulate cortex (MCC) in a patient undergoing seizure monitoring. Spectral power was computed across ictal states (preictal, ictal, and postictal) and level of consciousness (stupor/sleep vs. awake) in the DM nucleus and MCC.
  
  
  RESULTS
  Eighty-seven seizures of multifocal left frontal and temporal onsets were analyzed, characterized by loss of consciousness. At baseline, the left DM nucleus demonstrated rhythmic bursts of gamma activity, most frequently and with greatest amplitude during wakefulness. This activity ceased as ictal discharges spread to the MCC, and consciousness was impaired, and it recurred at the end of each seizure as awareness was regained. The analysis of gamma (30-40Hz) power demonstrated that when seizures occurred during wakefulness, there was lower DM ictal power (p<0.0001) and higher DM postictal power (p<0.0001) relative to the preictal epoch. This spectral pattern was not evident within the MCC or when seizures occurred during sleep.
  
  
  CONCLUSIONS
  Data revealed a characteristic pattern of DM gamma bursts during wakefulness, which disappeared during partial seizures associated with impaired consciousness. The findings are consistent with studies suggesting that the DM nucleus participates in cognition and arousal.
authors: Department of Neurology, Emory University, 101 Woodruff Circle, Suite 6000, Atlanta, GA 30322, USA. Electronic address: beth.a.leeman@emory.edu.
authors: B A
authors: BA
authors: Leeman-Markowski
authors: Department of Neurosurgery, Emory University, 101 Woodruff Circle, Suite 6000, Atlanta, GA 30322, USA. Electronic address: osmart@emory.edu.
authors: O L
authors: OL
authors: Smart
authors: Department of Neurology, Emory University, 101 Woodruff Circle, Suite 6000, Atlanta, GA 30322, USA. Electronic address: rfaught@emory.edu.
authors: R E
authors: RE
authors: Faught
authors: Department of Neurosurgery, Emory University, 101 Woodruff Circle, Suite 6000, Atlanta, GA 30322, USA. Electronic address: rgross@emory.edu.
authors: R E
authors: RE
authors: Gross
authors: Department of Neurology and Neurological Sciences, Stanford University, 300 Pasteur Drive (Room A343), Stanford, CA 94305-5235, USA. Electronic address: kmeador@stanford.edu.
authors: K J
authors: KJ
authors: Meador
mesh_terms: D000069279:Drug Resistant Epilepsy / Q000503:physiopathology; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000503:physiopathology*; D005260:Female; D065818:Gamma Rhythm; D006179:Gyrus Cinguli / Q000503:physiopathology; D006801:Humans; D020645:Mediodorsal Thalamic Nucleus / Q000503:physiopathology*; D008875:Middle Aged; D012640:Seizures / Q000503:physiopathology*; D014474:Unconsciousness / Q000503:physiopathology*
keywords: Complex partial seizures; Consciousness; Dorsomedial nucleus; EEG; Intracranial electrodes; Postictal state; Thalamus