title: Age-Dependency of Location of Epileptic Foci in "Continuous Spike-and-Waves during Sleep": A Parallel to the Posterior-Anterior Trajectory of Slow Wave Activity.
abstract: Epileptic encephalopathy with continuous spike-and-waves during sleep (CSWS) occurs during childhood and is characterized by an activation of spike wave complexes during slow wave sleep. The location of epileptic foci is variable, as is etiology. A relationship between the epileptic focus and age has been shown in various focal epilepsies following a posterior-anterior trajectory, and a link to brain maturation has been proposed. We hypothesize that in CSWS, maximal spike wave activity, corresponding to the epileptic focus, is related to age and shows a posterior-anterior evolution.
  
  
  
  In a retrospective cross-sectional study on CSWS (22 EEGs of 22 patients aged 3.1–13.5 years), the location of the epileptic focus is related to age and follows a posterior-anterior course. Younger patients are more likely to have posterior foci than older ones.
  
  
  
  We propose that the posterior-anterior trajectory of maximal spike waves in CSWS might reflect maturational changes of maximal expression of sleep slow waves, which follow a comparable course. Epileptic spike waves, that is, “hyper-synchronized slow waves” may occur at the place where the highest and therefore most synchronized slow waves meet brain tissue with an increased susceptibility to synchronization.
authors.affiliation: Division of Clinical Neurophysiology, University Children's Hospital Zurich, Zurich, Switzerland.
authors.forename: Bigna Katrin
authors.initials: BK
authors.lastname: Bölsterli Heinzle
authors.affiliation: Epilepsy Centre Kork, Kehl-Kork, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bast
authors.affiliation: Division of Clinical Neurophysiology, University Children's Hospital Zurich, Zurich, Switzerland.
authors.forename: Hanne
authors.initials: H
authors.lastname: Critelli
authors.affiliation: Pediatric Sleep Disorders Center, University Children's Hospital Zurich, Zurich, Switzerland.
authors.forename: Reto
authors.initials: R
authors.lastname: Huber
authors.affiliation: Division of Clinical Neurophysiology, University Children's Hospital Zurich, Zurich, Switzerland.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schmitt
mesh_terms: D000375:Aging; D058256:Brain Waves / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004569:Electroencephalography; D004828:Epilepsies, Partial / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D012890:Sleep / Q000502:physiology*; D013223:Statistics as Topic
keywords: CSWS; ESES; Sleep; Slow waves; Epileptic focus; Brain maturation