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Activation of spike and wave discharge in patients with generalized seizures

IN THE STUDY AND DIAGNOSIS of patients with seizure disorders, the electroencephalogram is of major importance but must be considered in context with other clinical findings. In the extreme, a patient may have a completely normal EEG yet have clinically established seizures; conversely, there may be patients with abnormal EEGs but no history of seizures. The recording of spike and wave or poly spike and wave bilaterally symmetrical EEG discharge is considered by some to be a prerequisite for the diagnosis of “idiopathic” or “centrencephalic” seizures. In the case of the absence attack or petit mal, the synchronous, relatively symmetrical 3-per-second spike and wave EEG paroxysm is consistently an electrical sign of the disorder. Generalized or “grand mal” seizures may be characterized electrographically by poly spike and wave or spike and wave EEG abnormalities which are of a faster frequency than those customarily associated with the absence attack. There is, however, less consistent correlation between EEG pattern and seizure type in major seizures. EEGs during hyperventilation, photic stimulation, and sleep are routine in patients who are suspected of having a seizure disorder. Hyperventilation is a potent activator of generalized spike and wave EEG abnormalities. Physiological or drug-induced sleep may potentiate focal or generalized spiking. In certain sensitive patients with generalized seizures, photic stimulation may activate spike and wave abnormalities. Convulsant drug-activating techniques have been abandoned by many EEG laboratories because of lack of reliable and meaningful data. Sleep deprivation is frequently a potent activator; however, the difficulties in obtaining all-night recordings are known. Barbiturate activation of focal and generalized epileptiform abnormalities has been shown The present study reports a new technique for EEG activation of paroxysmal, relatively synchronous, and symmetrical spike and poly spike and wave EEG discharge in patients with generalized seizure disorders. In this study, methohexital (Brevitalm) -an ultrarapid acting barbiturate used primarily for anesthesia induction-in very small intravenous doses has been shown to activate generalized seizure discharge.