Abstract
SUMMARYThe various sites of origin for the 3-cps symmetrical synchronous spike-wave discharge associated with petit mal epilepsy have been reviewed. Three clinical cases are reported in detail, in one of which chronic intracranial sub-temporal electrodes demonstrated a mesial temporal focus. Pathological findings are reported from 2 children with bilateral spike-wave paroxysms in the EEG, both of whom had clinical attacks of petit mal absence, and 1 of whom, in addition, displayed gelastic seizures and precocious puberty. Compression of brainstem structures by neoplasm was demonstrated in both. The evidence for a restraining influence of ascending brainstem pathways on the development of bilateral synchrony and for central or cortical genesis of the bilateral spike-wave discharge is reviewed. Possible impairment of the anatomical and biochemical integrity of ascending midbrain inhibitory systems by lateral brainstem compression during mesial temporal herniation associated with elevated intracranial pressure is considered as a possible predisposing factor in bilateral spike-wave discharge.
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