Focal Spikes: Causes & Reasons

Possible Causes for Focal Spikes

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]

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]

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]

Benign childhood epilepsy with centrotemporal spikes: Some older children may have focal or generalised seizures. [patient.info]

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]

(EEG) hallmark of focal-onset seizures is the focal interictal epileptiform spike or sharp wave. [emedicine.medscape.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]

A “leading” spike had a focal origin in all 42 type I spasms and involved the pre‐ or postcentral gyrus within 0.1 s in 37 of these spasms. [doi.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

We herein experienced 9 patients with primary thyroid lymphoma that developed during 3-18 years of ultrasonographic follow-up of Hashimoto's thyroiditis. All nine patients had localized mucosa-associated lymphoid tissue (MALT) lymphoma. Two patients had diffuse type, one had mixed type, and six had nodular type[…] [ncbi.nlm.nih.gov]

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]

Myoclonic-Astatic Epilepsy

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

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]

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]

Organic Brain Syndrome

A 57-year-old man with no personal or family history of manic-depressive disease developed symptoms of hypomania after a cerebrovascular accident and surgical trauma to the brain. The patient responded well to lithium carbonate treatment over a 2-year period. Although this therapy is contraindicated in cases of[…] [ncbi.nlm.nih.gov]

Benign Familial Infantile Epilepsy Type 4

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

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]

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

Hypoparathyroidism

[…] noun mass noun Medicine Diminished concentration of parathyroid hormone in the blood, which causes deficiencies of calcium and phosphorus compounds in the blood and results in muscular spasms. ‘Risks of parathyroid surgery include permanent hypoparathyroidism and damage to the recurrent laryngeal nerve.’[…] [en.oxforddictionaries.com]

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]

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]

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]

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]

Juvenile Absence Epilepsy

Collapse all Expand all Contexte Il s'agit d'une version mise à jour de la revue Cochrane publiée en 2017. Les crises d'absence (CA) sont de brèves crises d'épilepsie qui surviennent pendant l'enfance et l'adolescence. Selon les caractéristiques cliniques et les résultats de l'électroencéphalogramme (EEG), elles sont[…] [cochranelibrary.com]

16p13.3 Microduplication Syndrome

Awake: Focal spike prevalent in right parietal–occipital temporal areas and generalized spike-and-wave complexes. Figure 2. [docksci.com]

The propositus’ epileptic picture was more complex, since focal seizures have been associated with atypical absence seizures and continuous spikes and waves during slow sleep [docksci.com]

The first video polygraphic electroencephalography (EEG) during wakefulness and sleep showed a mild slowing of background activity, focal spikes prevalent in right parietal–occipital [docksci.com]

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]

Monosomy 2pter-p24

The reported EEG abnormalities consist in focal epileptic form or generalized spike-waves discharges [70]. [ncbi.nlm.nih.gov]

The spectrum of EEG abnormalities varies widely and includes hypsarrhythmia, focal and multifocal spikes and asymmetry of slow wave activity. [ncbi.nlm.nih.gov]

Spike-and-wave complexes are not a predominant feature. [ncbi.nlm.nih.gov]

Idiopathic Hemiconvulsion-Hemiplegia Syndrome

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

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]

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

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]