Focal Spikes: Causes & Reasons

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Possible Causes for Focal Spikes

Childhood Absence Epilepsy

Abstract The EEG in childhood absence epilepsy (CAE) may contain focal and generalised spike-wave discharges (SWDs) with focal, mainly frontal, "lead-in". [ncbi.nlm.nih.gov]

PURPOSE: To better understand the nature of the focal spike-wave discharges (FSWDs) and focally led generalized spike-wave discharges (GSWDs) in typical childhood absence [ncbi.nlm.nih.gov]

Abstract This chapter covers the syndromes of benign epilepsy with centrotemporal spikes (BECTS), nonlesional focal epilepsy in otherwise normal children (NLFN), and the genetic [ncbi.nlm.nih.gov]

Idiopathic Generalized Epilepsy

Fragmented generalized spike-and-wave can appear focal or multi-focal but usually is not consistently seen in 1 area. [medlink.com]

The EEG signature of IGE is bisynchronous, symmetric, and generalized spike-wave complex; although focal, irregular, and so called "fragments" of discharges are not uncommon [ncbi.nlm.nih.gov]

The morphology of the focal spike-and-wave typically appears similar to the generalized spike-and-wave. Ictal. [medlink.com]

Juvenile Myoclonic Epilepsy

We compared the occurrence and involvement of posterior electrodes for focal abnormalities and generalised spike-wave activity in the EEG outside photic stimulation between [ncbi.nlm.nih.gov]

Subtle focal abnormalities may be seen in 30%–50% of JME patients. 10 These may present as focal slow waves, spikes, or sharp waves or a focal onset of a generalised discharge [pmj.bmj.com]

Developmental and Epileptic Encephalopathy Type 3

 I stage is before the discovery of CSWS  The EEG shows multi-focal spikes and bisynchronous generalised sharp or spike-wave discharges.  II stage is when CSWS is found [slideshare.net]

[…] with centrotemporal EEG spikes Childhood epilepsy with occipital EEG paroxysms G40.1 Localization-related (focal)(partial) symptomatic epilepsy and epileptic syndromes with [apps.who.int]

polyspike-waves and independent focal or multifocal spikes) with randomly asynchronous attenuation. [neurologyindia.com]

Benign Adult Familial Myoclonic Epilepsy

 Previously called early-benign childhood seizures with occipital spikes  Childhood onset (peak 5 years).  Focal autonomic seizures or autonomic status epilepticus, frequently [slideshare.net]

[…] development Developmental regression Generalized hypotonia Epileptic spasms Babinski sign Cutaneous photosensitivity Hypomimic face Hand tremor Generalized-onset seizure Focal [mendelian.co]

According to Cantello et al., 55 focal subcortical reflex myoclonus can also be demonstrated in these patients. [clinicalgate.com]

Lennox-Gastaut Syndrome

Interictal There may be focal or multifocal spike-and-wave or sharp-slow waves, with an anterior predominance. [epilepsydiagnosis.org]

In LGS, major seizures are mainly atypical absences and tonic seizures with 0.5-2Hz slow spike-waves and eventually focal anomalies. [ncbi.nlm.nih.gov]

[…] discharges and in 5 (20.9%) of them the spike-wave complexes were not generalized but focal. [omicsonline.org]

Epilepsy

Focal EEG abnormalities commonly consisted of discrete spikes, sharp waves, or slow-wave activity. [jamanetwork.com]

Focal seizures began at 5 years and were refractory to medical treatment. [ncbi.nlm.nih.gov]

[…] paroxysmal abnormality (spikes and slow waves); (d) occurrence at any age in childhood and adulthood; (e) frequently demonstrable aetiology (tumor, vascular); and (f) no [medlink.com]

West Syndrome

Brain MRI revealed no abnormal findings although interictal EEG demonstrated left centro-parieto-temporal localized spike foci. [ncbi.nlm.nih.gov]

At time they appear to be focal, and a few seconds later they seem to originate from multiple foci. [en.wikipedia.org]

The spikes usually alternate randomly between focal, multifocal, and generalized discharges at different moments within a brief record. [web.archive.org]

Neonatal Seizures

spike discharges in infancy. [ncbi.nlm.nih.gov]

In birth injury or cerebral anoxia, EEG mostly revealed focal-unilateral abnormality or suppression-burst activity in newborns and hypsarhythmia or focal features in infants [ncbi.nlm.nih.gov]

[…] infantile convulsion or breath-holding spell. 6) EEG features of cerebral malformation were asymmetrical or multifocal dischages in neonatal period and hypsarhythmia or focal-unilateral [ncbi.nlm.nih.gov]

Hypoxic-Ischemic Brain Injury

Interictal The interictal EEG may be normal or may show focal or multi-focal interictal spikes or spike-and-wave over the location(s) of the brain injury. [epilepsydiagnosis.org]

Dysfunctions probably located in the brainstem and diencephalon, or in their non specific projections, would explain the coexistence of spike and wave activity and OIRDA in [scielo.br]

Multi-focal independent spikes or generalized spike-and-wave (usually < 3 Hz) can be seen in young patients who evolve to have generalized seizure types. [epilepsydiagnosis.org]

Uremic Encephalopathy

[…] paroxysms of sharp waves and spike-waves during hyperventilation (HV). [38] In patients with cirrhosis, in addition to diffuse slow activity (theta and delta), triphasic [neurologyindia.com]

[…] of periodic lateralized epileptiform discharges (PLEDS). [37] In hypokalemia, diffuse slow activity can be seen together with paroxysmal delta/theta activity, as well as focal [neurologyindia.com]

Encephalopathy

*Frontal dominance (FIRDA) --non specific ,diffuse encephalopathy, if focal ? [slideshare.net]

[…] of periodic lateralized epileptiform discharges (PLEDS).[37] In hypokalemia, diffuse slow activity can be seen together with paroxysmal delta/theta activity, as well as focal [neurologyindia.com]

*Repetitive and fairly stereotyped waveforms appearing at regular intervals, sharps/spike waves or complex discharges. [slideshare.net]

Toxic Encephalopathy

[…] paroxysms of sharp waves and spike-waves during hyperventilation (HV). [38] In patients with cirrhosis, in addition to diffuse slow activity (theta and delta), triphasic [neurologyindia.com]

Familial Progressive Myoclonic Epilepsy

[…] and wave or generalized spike and wave are associated with myoclonic jerks Focal Akinetic Seizure: Focal paresis precedes convulsive activity in the affected part Focal paresis [neurodiffdx.com]

Mutations in GRIN2A cause idiopathic focal epilepsy with rolandic spikes. Nat Genet 2013; 45 (9) 1067-1072 143 Lesca G, Rudolf G, Bruneau N, et al. [thieme-connect.com]

The cortical site of origin of the spike discharges and the site of origin of the associated focal myoclonic seizures do not necessarily coincide. 22 Pathophysiology The term [neupsykey.com]

Hashimoto Thyroiditis

History Hypothyroidism is usually insidious in onset, with signs and symptoms slowly progressing over months to years. Most commonly, patients do not relate a history suggestive of transient hyperthyroidism secondary to increased T4 and T3 levels resulting from thyrocyte destruction. The time course is influenced[…] [emedicine.medscape.com]

Acquired Epileptic Aphasia

Awake EEG record, showed bilateral spike and wave discharges in the frequency of 2 to 3Hz and also showed some focal spikes predominantly in right frontal area ( Fig. 1 ). [indianpediatrics.net]

In an overwhelming majority of the investigated cases, the maps of the single discharges constituting sleep activation are identical; with focal/regional interictal spikes [psjd.icm.edu.pl]

A sleep EEG recording showed focal spike and wave discharges over the right central and temporal leads (C4-T4). [intechopen.com]

Organic Brain Syndrome

An organic brain syndrome ( OBS ), also known as an organic brain disease/disorder ( OBD ), an organic mental syndrome ( OMS ), or an organic mental disorder ( OMD ), is a syndrome or disorder of mental function whose cause is alleged to be known as organic ( physiologic ) rather than purely of the mind. These[…] [en.wikipedia.org]

Myoclonic-Astatic Epilepsy

In contrast, all cases with a poor prognosis had focal spike discharges. [ncbi.nlm.nih.gov]

Early onset and focal spike discharges as indicators of poor prognosis for myoclonic-astatic epilepsy. Brain Dev. 2014 Aug;36(7):613-9. [pediatricfocus.wordpress.com]

or polyspike-wave EEG discharges at 2-3 Hz, without focal spike discharges; and (4) exclusion of severe and benign myoclonic epilepsy (SME, BME) in infants and cryptogenic [ncbi.nlm.nih.gov]

Hypoparathyroidism

Hypoparathyroidism NORD gratefully acknowledges Dolores Shoback, MD, Professor of Medicine, UCSF Endocrine Research Unit - 111N, SF - VA Medical Center, for assistance in the preparation of this report. Subdivisions of Hypoparathyroidism acquired hypoparathyroidism autoimmune hypoparathyroidism congenital[…] [rarediseases.org]

Insulin Overdose

We report a very rare case of acute pulmonary edema caused by hypoglycemia from insulin overdose during an attempted suicide. A 16-year-old woman with type 1 diabetes was brought to our hospital because of hypoglycemic coma. She exhibited severe hypoxia; upon intubation, bloody froth poured out of the tube.[…] [ncbi.nlm.nih.gov]

Rolandic Epilepsy

Focal spikes and sharp waves with predominantly centrotemporal localization are the electroencephalograhic hallmark of Rolandic epilepsy (or BECTS). [ncbi.nlm.nih.gov]

focal or generalized spikes and waves. [ncbi.nlm.nih.gov]

So the EEG typically shows dramatic focal spikes in the centrotemporal region of brain. [chp.edu]

Focal Epilepsy - Speech Disorder - Mental Retardation

Uni-Focal Spikes Can be due to superficial or deep cortical or thalamic lesions. [studystack.com]

 I stage is before the discovery of CSWS  The EEG shows multi-focal spikes and bisynchronous generalised sharp or spike-wave discharges.  II stage is when CSWS is found [slideshare.net]

Benign Familial Infantile Epilepsy Type 4

Epilepsies Genetic Generalized Epilepsies—Epilepsies With Generalized Spike–Waves Chapter 17: Myoclonic Epilepsy in Infancy and Epilepsy With Myoclonic Atonic Seizures Chapter [connect.springerpub.com]

DeMarco, P., and Negrin, P., Parietal focal spikes evoked by contralateral tactile somatotopic stimulation in four non-epileptic subjects, Electroenceph. clin. [journals.sagepub.com]

[…] the EEG showed low voltage undifferentiated activity with frequent ictal pattern and occasional focal spikes and sharp waves. [karger.com]

Progressive Myoclonic Epilepsy Type 3

EEG: Generalized almost symmetrical high-voltage polyspikes-and-wave along with frequent bilateral independent posterior dominant (T6, O2//T5, O1) focal spikes on a slow & [pubs.sciepub.com]

EEG revealed abundant generalized almost symmetrical high-voltage polyspike-and-wave along with frequent bilateral independent posterior dominant (T6, O2//T5, O1) focal spikes [pubs.sciepub.com]

Juvenile Absence Epilepsy

Childhood Absence Seizures

Abstract The electrographic hallmark of childhood absence seizures is 3 Hz generalized spike and wave discharges; however, there is likely a focal thalamic or cortical onset [ncbi.nlm.nih.gov]

Evidence of preictal magnetoencephalography frequency changes were detected a mean of 694 ms before the initial spike on the EEG. [ncbi.nlm.nih.gov]

A consistent pattern of focal sources was present in the frontal cortex and thalamus during this preictal period, but source localization occurred synchronously so that independent [ncbi.nlm.nih.gov]

Benign Familial Neonatal Epilepsy Type 3

[…] with midline spikes and waves during sleep (BIMSE) (see these terms). [orpha.net]

Other differential diagnoses are benign non-familial infantile seizures, benign infantile seizures associated with mild gastroenteritis and benign infantile focal epilepsy [orpha.net]

Blitz-Nick-Salaam Attacks

Typically, the interictal pattern is hypsarrhythmia (chaotic, high-voltage polymorphic delta and theta waves with superimposed multifocal spike discharges). [msdmanuals.com]

Multiple variations (eg, focal or asymmetric hypsarrhythmia) are possible. The ictal pattern is usually a sudden, marked and diffuse attenuation of electrical activity. [msdmanuals.com]

Idiopathic Hemiconvulsion-Hemiplegia Syndrome

Idiopathic childhood focal epilepsy with centrotemporal spikes, which is more known as rolandic ..." [rjdn.abvpress.ru]

Ictal EEG Focal discharges of slow waves and spikes. There is no consistent relation between clonic convulsions and EEG discharges. [epilepsy.com]

Benign focal epilepsy in infants with central and vertex spikes and waves during sleep Benign focal epilepsy in infants with central and vertex spikes and waves during sleep [intechopen.com]

Familial Infantile Myoclonic Epilepsy

[…] the EEG showed low voltage undifferentiated activity with frequent ictal pattern and occasional focal spikes and sharp waves. [karger.com]

Called benign infantile focal epilepsy with midline spikes and waves during sleep, these infants have few seizures and there may often be a family history.[2] References[edit [en.wikipedia.org]

[…] with midline spikes and waves during sleep (BIMSE) (see these terms). [rarediseases.info.nih.gov]