Electroencephalographic Evidence of Thalamic and Hypothalamic Epilepsy

Abstract

14 and 6/sec. positive spikes have been encountered during sleep in 6% of patients with a clinical history of epileptiform disorder, and 2% of 300 control subjects. Such spikes are distorted forms of the normal sleep patterns, which have been shown in animals to originate in the thalamus and hypothalamus. The diffuseness of the discharge and the general positivity of the spikes suggest a subcortical origin. The clinical correlates of 14 and 6/sec. positive spike discharges suggest epileptic disorder in the thalamus and hypothalamus; attacks of pain, rage, and vegetative symptoms are common. Though easily confused with psychomotor epilepsy and other epileptic syndromes, general and specific differences usually permit the informed physician to make a correct clinical diagnosis even without an eeg., but a record of the electrical activity of the cortex in sleep clinches the diagnosis. As compared with other types of epileptic and epileptiform disorder, 14 and 6/sec. positive spikes are relatively benign. A few discharges of this pattern, particularly in children, in the absence of symptoms should not be regarded too seriously. They are likely to remain asymptomatic and disappear with increasing age. When symptoms are present, demonstration of such disorder is important not only as an aid to diagnosis, but as a clue to treatment. Fortunately, such disorder usually responds well to a combination of Dilantin and phenobarbital, or Dilantin and Mesantoin.