Uppermost synchronized generators of spike–wave activity are localized in limbic cortical areas in late-onset absence status epilepticus

PURPOSE Absence status (AS) epilepticus with generalized spike-wave pattern is frequently found in severely ill patients in whom several disease states co-exist. The cortical generators of the ictal EEG pattern and EEG functional connectivity (EEGfC) of this condition are unknown. The present study investigated the localization of the uppermost synchronized generators of spike-wave activity in AS. METHOD Seven patients with late-onset AS were investigated by EEG spectral analysis, LORETA (Low Resolution Electromagnetic Tomography) source imaging, and LSC (LORETA Source Correlation) analysis, which estimates cortico-cortical EEGfC among 23 ROIs (regions of interest) in each hemisphere. RESULTS All the patients showed generalized ictal EEG activity. Maximum Z-scored spectral power was found in the 1-6 Hz and 12-14 Hz frequency bands. LORETA showed that the uppermost synchronized generators of 1-6 Hz band activity were localized in frontal and temporal cortical areas that are parts of the limbic system. For the 12-14 Hz band, abnormally synchronized generators were found in the antero-medial frontal cortex. Unlike the rather stereotyped spectral and LORETA findings, the individual EEGfC patterns were very dissimilar. CONCLUSION The findings are discussed in the context of nonconvulsive seizure types and the role of the underlying cortical areas in late-onset AS. The diversity of the EEGfC patterns remains an enigma. Localizing the cortical generators of the EEG patterns contributes to understanding the neurophysiology of the condition.