Study Identifies Cortically Driven Process in Lennox-Gastaut Syndrome

A study assessing brain regions underlying interictal generalized paroxysmal fast activity (GPFA) found reproducible evidence of a cortically driven process within the epileptic network of Lennox-Gastaut syndrome (LGS). The study included 10 children and 15 adults who underwent concurrent scalp EEG-fMRI with and without anesthesia, respectively, during which a total of 1045 GPFA events were identified (cumulative duration, 1433 seconds). Assessment of these events revealed the following:

• Activation occurred in distributed association cortical areas, thalamus, and brainstem (P <.05, corrected for family-wise error).
• Activation was similar across individual patients, particularly in the frontoparietal cortex, regardless of the etiology of their epilepsy (ie, structural, genetic, unknown).
• Dynamic casual modeling indicated GPFA was most likely driven by the prefrontal cortex, with propagation occurring first to the brainstem and then from the brainstem to the thalamus.

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Reference

Warren AEL, Harvey AS, Vogrin SJ, et al. The epileptic network of Lennox-Gastaut syndrome: cortically driven and reproducible across age. Neurology. 2019 Jun 21. pii: 10.1212/WNL.0000000000007775. doi: 10.1212/WNL.0000000000007775.