Practices for respecting the newborn's sleep-wake cycle: Interventional study in the neonatal intensive care unit

Objectives

Premature newborns are exposed to a great deal of over-stimulation, which can affect their cerebral development. For better sleep, certain practices should be recommended. The aim of this study was to evaluate the effect of a professional training program on the improvement of practices promoting respect for the newborn's sleep-wake cycle.

Materials and Methods

This was an interventional study with a longitudinal, single-group, and before-and-after design. The experimental design followed a three-stage time series: Eight months before, three months after, then eight months after intervention. It targeted a comprehensive sample of 66 professionals. It took place between October 2020 and March 2022 at the Neonatal Intensive Care Unit of the Hassan II University Hospital in Fez, Morocco. It was based on an observation grid and a self-administered questionnaire, validated and tested with a Cronbach's alpha reliability of 0.91.

Results

The light environment showed significant differences between the 1st and 3rd step (3.3% vs. 45.0%; P = 0.02; confidence interval [CI] = 13.644-10.456) for knowledge and (13.3% vs. 78.3%; P = 0.01; CI = 14.412-10.888) for practices; the noise environment showed a positive improvement between the 2nd and 3rd intervention (31.7% vs. 41.7%; P < 0.001; CI = 5.954-2.913) for knowledge and (65.0% vs. 73.3%; P < 0.001; CI = 3.597-1.236) for practices, with an average of (8.98 ± 0.30-28.15 ± 0.48; CI = 3.806-1.094) between the 1st and 3rd step. Practices surrounding sleep and wakefulness reported significant improvement between the three periods (14.35 ± 0.22 vs. 18.10 ± 0.35 vs. 19.90 ± 0.35; P P < 0.001; CI = 4.647-2.853) for sleep and (13.25 ± 0.48 vs. 22.27 ± 0.59; P < 0.001; CI = 10.563-7.471) for wakefulness with statistically significant correlations between knowledge and practices (0.426**) for sleep and (0.606**) for wakefulness.

Conclusion

The study demonstrated the positive impact of this sleep management and assessment program on the development of professional skills. Its implementation requires rigorous application of developmental support strategies for individualized care in neonatology.

Sleep-wake dependent hippocampal regulation of fear memory

The hippocampus (HPC) plays a pivotal role in fear learning and memory. Our two recent studies suggest that rapid eye movement (REM) sleep via the HPC downregulates fear memory consolidation and promotes fear extinction. However, it is not clear whether and how the dorsal and the ventral HPC regulates fear memory differently; and how the HPC in wake regulates fear memory. By chemogenetic stimulating in the HPC directly and its afferent entorhinal cortex that selectively activated the HPC in REM sleep for 3-6 h post-fear-acquisition, we found that HPC activation in REM sleep consolidated fear extinction memory. In particular, dorsal HPC (dHPC) stimulation in REM sleep virtually eliminated fear memory by enhancing fear extinction and reducing fear memory consolidation. By contrast, chemogenetic stimulating HPC afferent the supramammillary nucleus (SUM) induced 3-hr wake with HPC activation impaired fear extinction. Finally, desipramine (DMI) injection that selectively eliminated REM sleep for >6 h impaired fear extinction. Our results demonstrate that the HPC is critical for fear memory regulation; and wake HPC and REM sleep HPC have an opposite role in fear extinction of respective impairment and consolidation.

Dynamic networks of physiologic interactions of brain waves and rhythms in muscle activity

The brain plays a central role in facilitating vital body functions and in regulating physiological and organ systems, including the skeleto-muscular and locomotor system. While neural control is essential to synchronize and coordinate activation of various muscle groups and muscle fibers within muscle groups in relation to body movements and distinct physiologic states, the dynamic networks of brain-muscle interactions have not been explored and the complex regulatory mechanism of brain-muscle control remains unknown. Here we present a first study of network interactions between brain waves at different cortical locations and peripheral muscle activity across key physiologic states - wake, sleep and distinct sleep stages. Utilizing a novel approach based on the Network Physiology framework and the concept of time delay stability, we find that for each physiologic state the network of cortico-muscular interactions is characterized by a specific hierarchical organization of network topology and network links strength, where particular brain waves are main mediators of interaction and control of muscular activity. Further, we uncover that with transition from one physiological state to another, the brain-muscle interaction network undergoes marked reorganization in the profile of network links strength, indicating a direct association between network structure and physiological state and function. The pronounced stratification in brain-muscle network characteristics across sleep stages is consistent for chin and leg muscle groups and persists across subjects, indicating a remarkable universality and a previously unrecognized basic physiologic mechanism that regulates muscle activity even during rest and in the absence targeted direct movement. Our findings demonstrate previously unrecognized coordination between brain waves and activation of different muscle fiber types within muscle groups, laws of brain-muscle cross-communication and principles of network integration and control. These investigations demonstrate the potential of network-based biomarkers for classification of distinct physiological states and conditions, for the diagnosis and prognosis of neurodegenerative, movement and sleep disorders, and for developing efficient treatment strategies.

The influence of oxytocin-based interventions on sleep-wake and sleep-related behaviour and neurobiology: A systematic review of preclinical and clinical studies

The oxytocin (OXT) system has garnered considerable interest due to its influence on diverse behaviours. However, scant research has considered the influence of oxytocin on sleep-wake and sleep-related behaviour and neurobiology. Consequently, the objective of this systematic review was to assess the extant preclinical and clinical evidence for the influence of oxytocin-based interventions on sleep-wake outcomes. The primary search was conducted on 22/7/2020 using six electronic databases; 30 studies (19 preclinical, 11 clinical) were included based on inclusion criteria. Studies were evaluated for risk of bias using the SYRCLE tool and the Cochrane risk of bias tools for preclinical and clinical studies, respectively. Results indicated manipulation of the OXT system can influence sleep-wake outcomes. Preclinical evidence suggests a wake-promoting influence of OXT system activation whereas the clinical evidence suggests little or no sleep-promoting influence of OXT. OXT dose was identified as a likely modulatory factor of OXT-induced effects on sleep-wake behaviour. Future studies are necessary to validate and strengthen these tentative conclusions about the influence of OXT on sleep-wake behaviour.

Effects of propofol on sleep architecture and sleep-wake systems in rats

Previous studies have shown that the synchronization of electroencephalogram (EEG) signals is found during propofol-induced general anesthesia, which is similar to that of slow-wave sleep (SWS). However, a complete understanding is lacking in terms of the characteristics of EEG changes in rats after propofol administration and whether propofol acts through natural sleep circuits. Here, we examined the characteristics of EEG patterns induced by intraperitoneal injection of propofol in rats. We found that high (10 mg/kg) and medium (5 mg/kg) doses of propofol induced a cortical EEG of low-frequency, high-amplitude activity with rare electromyographic activity and markedly shortened sleep latency. The high dose of propofol increased deep slow-wave sleep (SWS2) to 4 h, as well as the number of large SWS2 bouts (>480 s), their mean duration and the peak of the power density curve in the delta range of 0.75-3.25 Hz. After the medium dose of propofol, the total number of wakefulness, light slow-wave sleep (SWS1) and SWS2 episodes increased, whereas the mean duration of wakefulness decreased. The high dose of propofol significantly increased c-fos expression in the ventrolateral preoptic nucleus (VLPO) sleep center and decreased the number of c-fos-immunoreactive neurons in wake-related systems including the tuberomammillary nucleus (TMN), perifornical nucleus (PeF), lateral hypothalamic nucleus (LH), ventrolateral periaqueductal gray (vPAG) and supramammillary region (SuM). These results indicated that the high dose of propofol produced high-quality sleep by increasing SWS2, whereas the medium dose produced fragmented and low-quality sleep by disrupting the continuity of wakefulness. Furthermore, sleep-promoting effects of propofol are correlated with activation of the VLPO cluster and inhibition of the TMN, PeF, LH, vPAG and SuM.

A wake-like state in vitro induced by transmembrane TNF/soluble TNF receptor reverse signaling

Tumor necrosis factor alpha (TNF) has sleep regulatory and brain development roles. TNF promotes sleep in vivo and in vitro while TNF inhibition diminishes sleep. Transmembrane (tm) TNF and the tmTNF receptors (Rs), are cleaved by tumor necrosis factor alpha convertase to produce soluble (s) TNF and sTNFRs. Reverse signaling occurs in cells expressing tmTNF upon sTNFR binding. sTNFR administration in vivo inhibits sleep, thus we hypothesized that a wake-like state in vitro would be induced by sTNFR-tmTNF reverse signaling. Somatosensory cortical neuron/glia co-cultures derived from male and female mice lacking both TNFRs (TNFRKO), or lacking TNF (TNFKO) and wildtype (WT) mice were plated onto six-well multi-electrode arrays. Daily one-hour electrophysiological recordings were taken on culture days 4 through 14. sTNFR1 (0.0, 0.3, 3, 30, 60, and 120 ng/µL) was administered on day 14. A final one-hour recording was taken on day 15. Four measures were characterized that are also used to define sleep in vivo: action potentials (APs), burstiness index (BI), synchronization of electrical activity (SYN), and slow wave power (SWP; 0.25-3.75 Hz). Development rates of these emergent electrophysiological properties increased in cells from mice lacking TNF or both TNFRs compared to cells from WT mice. Decreased SWP, after the three lowest doses (0.3, 3 and 30 ng/µL) of the sTNFR1, indicate a wake-like state in cells from TNFRKO mice. A wake-like state was also induced after 3 ng/µl sTNFR1 treatment in cells from TNFKO mice, which express the TNFR1 ligand, lymphotoxin alpha. Cells from WT mice showed no treatment effects. Results are consistent with prior studies demonstrating involvement of TNF in brain development, TNF reverse signaling, and sleep regulation in vivo. Further, the current demonstration of sTNFR1 induction of a wake-like state in vitro is consistent with the idea that small neuronal/glial circuits manifest sleep- and wake-like states analogous to those occurring in vivo. Finally, that sTNF forward signaling enhances sleep while sTNFR1 reverse signaling enhances a wake-like state is consistent with other sTNF/tmTNF/sTNFR1 brain actions having opposing activities.

Nigrostriatal and mesolimbic control of sleep-wake behavior in rat

The midbrain dopamine system via the dorsal and ventral striatum regulates a wide range of behaviors. To dissect the role of dopaminergic projections to the dorsal striatum (nigrostriatal projection) and ventral striatum (mesolimbic projection) in sleep-wake behavior, we selectively chemogenetically stimulated nigrostriatal or mesolimbic projections and examined the resulting effects on sleep in rats. Stimulation of nigrostriatal pathways increased sleep and EEG delta power, while stimulation of mesolimbic pathways decreased sleep and reduced cortical EEG power. These results indicate that midbrain dopamine signaling in the dorsal or ventral striatum promotes sleep or wake, respectively.

Hydrodynamic function of dorsal fins in spiny dogfish and bamboo sharks during steady swimming

A key feature of fish functional design is the presence of multiple fins that allow thrust vectoring and redirection of fluid momentum to contribute to both steady swimming and maneuvering. A number of previous studies have analyzed the function of dorsal fins in teleost fishes in this context, but the hydrodynamic function of dorsal fins in freely swimming sharks has not been analyzed, despite the potential for differential functional roles between the anterior and posterior dorsal fins. Previous anatomical research has suggested a primarily stabilizing role for shark dorsal fins. We evaluated the generality of this hypothesis by using time-resolved particle image velocimetry to record water flow patterns in the wake of both the anterior and posterior dorsal fins in two species of freely swimming sharks: bamboo sharks (Chiloscyllium plagiosum) and spiny dogfish (Squalus acanthias). Cross-correlation analysis of consecutive images was used to calculate stroke-averaged mean longitudinal and lateral velocity components, and vorticity. In spiny dogfish, we observed a velocity deficit in the wake of the first dorsal fin and flow acceleration behind the second dorsal fin, indicating that the first dorsal fin experiences net drag while the second dorsal fin can aid in propulsion. In contrast, the wake of both dorsal fins in bamboo sharks displayed increased net flow velocity in the majority of trials, reflecting a thrust contribution to steady swimming. In bamboo sharks, fluid flow in the wake of the second dorsal fin had higher absolute average velocity than that for first dorsal fin, and this may result from a positive vortex interaction between the first and second dorsal fins. These data suggest that the first dorsal fin in spiny dogfish has primarily a stabilizing function, while the second dorsal fin has a propulsive function. In bamboo sharks, both dorsal fins can contribute thrust and should be considered as propulsive adjuncts to the body during steady swimming. The function of shark dorsal fins can thus differ considerably among fins and species, and is not limited to a stabilizing role.

The excitatory/inhibitory input to orexin/hypocretin neuron soma undergoes day/night reorganization

Orexin (OX)/hypocretin-containing neurons are main regulators of wakefulness stability, arousal, and energy homeostasis. Their activity varies in relation to the animal's behavioral state. We here tested whether such variation is subserved by synaptic plasticity phenomena in basal conditions. Mice were sacrificed during day or night, at times when sleep or wake, respectively, predominates, as assessed by electroencephalography in matched mice. Triple immunofluorescence was used to visualize OX-A perikarya and varicosities containing the vesicular glutamate transporter (VGluT)2 or the vesicular GABA transporter (VGAT) combined with synaptophysin (Syn) as a presynaptic marker. Appositions on OX-A⁺ somata were quantitatively analyzed in pairs of sections in epifluorescence and confocal microscopy. The combined total number of glutamatergic (Syn⁺/VGluT2⁺) and GABAergic (Syn⁺/VGAT⁺) varicosities apposed to OX-A somata was similar during day and night. However, glutamatergic varicosities were significantly more numerous at night, whereas GABAergic varicosities prevailed in the day. Triple immunofluorescence in confocal microscopy was employed to visualize synapse scaffold proteins as postsynaptic markers and confirmed the nighttime prevalence of VGluT2⁺ together with postsynaptic density protein 95⁺ excitatory contacts, and daytime prevalence of VGAT⁺ together with gephyrin⁺ inhibitory contacts, while also showing that they formed synapses on OX-A⁺ cell bodies. The findings reveal a daily reorganization of axosomatic synapses in orexinergic neurons, with a switch from a prevalence of excitatory innervation at a time corresponding to wakefulness to a prevalence of inhibitory innervations in the antiphase, at a time corresponding to sleep. This reorganization could represent a key mechanism of plasticity of the orexinergic network in basal conditions.

How should a bio-mathematical model be used within a fatigue risk management system to determine whether or not a working time arrangement is safe?

Bio-mathematical models that predict fatigue and/or sleepiness have proved a useful adjunct in the management of what has been typically referred to as fatigue-related risk. Codifying what constitutes appropriate use of these models will be increasingly important over the next decade. Current guidelines for determining a safe working time arrangement based on model outputs generally use a single upper threshold and are, arguably, over-simplistic. These guidelines fail to incorporate explicitly essential aspects of the risk assessment process - namely, the inherent uncertainty and variability in human sleep-wake behavior; the non-linear relationship between fatigue, task performance and safety outcomes; the consequence of a fatigue-related error and its influence on overall risk; and the impact of risk mitigation or controls in reducing the likelihood or consequence of a fatigue-related error. As industry and regulatory bodies increasingly move toward performance-based approaches to safety management, any fatigue risk management system that includes a bio-mathematical model should specify what exactly is measured by the model, and how the model can be used in the context of a safety management system approach. This will require significant dialog between the various parties with an interest in bio-mathematical models, i.e. developers, vendors, end-users, and regulators.

Hydrodynamic study of freely swimming shark fish propulsion for marine vehicles using 2D particle image velocimetry

Two-dimensional velocity fields around a freely swimming freshwater black shark fish in longitudinal (XZ) plane and transverse (YZ) plane are measured using digital particle image velocimetry (DPIV). By transferring momentum to the fluid, fishes generate thrust. Thrust is generated not only by its caudal fin, but also using pectoral and anal fins, the contribution of which depends on the fish’s morphology and swimming movements. These fins also act as roll and pitch stabilizers for the swimming fish. In this paper, studies are performed on the flow induced by fins of freely swimming undulatory carangiform swimming fish (freshwater black shark, L = 26 cm) by an experimental hydrodynamic approach based on quantitative flow visualization technique. We used 2D PIV to visualize water flow pattern in the wake of the caudal, pectoral and anal fins of swimming fish at a speed of 0.5–1.5 times of body length per second. The kinematic analysis and pressure distribution of carangiform fish are presented here. The fish body and fin undulations create circular flow patterns (vortices) that travel along with the body waves and change the flow around its tail to increase the swimming efficiency. The wake of different fins of the swimming fish consists of two counter-rotating vortices about the mean path of fish motion. These wakes resemble like reverse von Karman vortex street which is nothing but a thrust-producing wake. The velocity vectors around a C-start (a straight swimming fish bends into C-shape) maneuvering fish are also discussed in this paper. Studying flows around flapping fins will contribute to design of bioinspired propulsors for marine vehicles.

Randomized controlled trial to compare sleep and wake in preterm infants less than 32weeks of gestation receiving two different modes of non-invasive respiratory support

AIM

To determine whether respiratory support via heated humidified high flow nasal cannulae (HHHFNC) results in infants <32weeks gestation spending a greater proportion of time in sleep compared to those receiving nasal continuous positive airway pressure (NCPAP).

METHODS

A subgroup of infants enrolled in a randomized controlled trial to compare HHHFNC or NCPAP post-extubation had sleep and wake activity measured by actigraphy for 72hours post-extubation. Activity diaries were completed contemporaneously to record episodes of infant handling. Actigraphy data were downloaded with known periods of handling excluded from the analysis.

RESULTS

28 infants with mean gestation of 28.3weeks (SD 2) and birth weight 1074g (SD 371) were studied. Infants receiving HHHFNC spent a lesser proportion of time in sleep 59.8% (SD 18.5) than those on NCPAP 82.2% (SD 23.8) p=0.004. Infants receiving HHHFNC had a lower sleep efficiency and higher mean activity score than those on NCPAP (p=0.003, p=0.002, respectively).

CONCLUSION

Infants receiving HHHFNC had a higher mean activity score and spent less time in sleep than those allocated NCPAP. Further study of sleep wake activity in preterm infants receiving respiratory support is required as this may impact on neurodevelopmental outcomes.

Neocortical focus: experimental view

All brain normal or pathological activities occur in one of the states of vigilance: wake, slow-wave sleep, or REM sleep. Neocortical seizures preferentially occur during slow-wave sleep. We provide a description of neuronal behavior and mechanisms mediating such a behavior within neocortex taking place in natural states of vigilance as well as during seizures pointing to similarities and differences exhibited during sleep and seizures. A concept of epileptic focus is described using a model of cortical undercut, because in that model, the borders of the focus are well defined. In this model, as in other models of acquired epilepsy, the main factor altering excitability is deafferentation, which upregulates neuronal excitability that promotes generation of seizures. Periods of disfacilitation recorded during slow-wave sleep further upregulate neuronal excitability. It appears that the state of neurons and neuronal network in the epileptic focus produced by deafferentation are such that seizures cannot be generated there. Instead, seizures always start around the perimeter of the undercut cortex. Therefore, we define these areas as the seizure focus. In this zone, neuronal connectivity and excitability are moderately enhanced, lowering the threshold for seizure generation.

Human activity and rest in situ

Our lives are structured by the daily alternation of activity and rest, of wake and sleep. Despite significant advances in circadian and sleep research, we still lack answers to many of the most fundamental questions about this conspicuous behavioral pattern. We strongly believe that investigating this pattern in entrained conditions, real-life and daily contexts-in situ-will help the field to elucidate some of these central questions. Here, we present two common approaches for in situ investigation of human activity and rest: the Munich ChronoType Questionnaire (MCTQ) and actimetry. In the first half of this chapter, we provide detailed instructions on how to use and interpret the MCTQ. In addition, we give an overview of the main insights gained with this instrument over the past 10 years, including some new findings on the interaction of light and age on sleep timing. In the second half of this chapter, we introduce the reader to the method of actimetry and share our experience in basic analysis techniques, including visualization, smoothing, and cosine model fitting of in situ recorded data. Additionally, we describe our new approach to automatically detect sleep from activity recordings. Our vision is that the broad use of such easy techniques in real-life settings combined with automated analyses will lead to the creation of large databases. The resulting power of big numbers will promote our understanding of such fundamental biological phenomena as sleep.

Distinct pro-vigilant profile induced in rats by the mGluR5 potentiator LSN2814617

While treatment options are available, excessive daytime sleepiness (EDS) remains a significant unmet medical need for many patients. Relatively little rodent behavioural pharmacology has been conducted in this context to assess potential pro-vigilant compounds for their ability to restore functional capacity following experimentally induced sleep loss. Male Wistar rats were prepared for electroencephalographic (EEG) recording and subject to 11 h of sleep restriction using a biofeedback-induced cage rotation protocol. A simple response latency task (SRLT) was used to behaviourally index sleep restriction and the effects of pro-vigilant compounds: modafinil, D-amphetamine, caffeine, and the mGlu5-positive allosteric modulator LSN2814617. Sleep restriction resulted in a consistent, quantified loss of non-rapid eye movement (NREM) and REM sleep that impaired SRLT performance in a manner suggestive of progressive task disengagement. In terms of EEG parameters, all compounds induced wakefulness. Amphetamine treatment further decreased SRLT performance capacity, whereas the other three compounds decreased omissions and allowed animals to re-engage in the task. Caffeine and modafinil also significantly increased premature responses during this period, an effect not observed for LSN2814617. While all compounds caused compensatory sleep responses, the magnitude of compensation observed for LSN2814617 was much smaller than would be predicted to result from the prolongation of wakefulness exhibited. Using simple response latencies to index performance, an mGlu5 PAM dramatically increased wakefulness and improved functional capacity of sleep-restricted animals, without eliciting a proportionate compensatory sleep response. This effect was qualitatively distinct from that of amphetamine, caffeine and modafinil.

Validation of actigraphy with continuous video-electroencephalography in children with epilepsy

BACKGROUND

The relationship between epilepsy and sleep is bidirectional as seizures disrupt sleep and coexisting sleep disorders have detrimental effects on seizure control and quality of life for both the children and their families. Previous research has reported on sleep disturbance in children with epilepsy primarily by subjective parental reports. Actigraphy may provide a more accurate objective evaluation of sleep, but the validity of this sleep measure for children with epilepsy has not yet been assessed. The primary objective of this study was to validate the use of actigraphy as a tool in studying sleep patterns in children with epilepsy.

METHODS

This was a prospective study comparing sleep and wake epochs recorded for 24 h simultaneously by actigraphy and by continuous video-electroencephalography (VEEG) monitoring in 27 patients aged 2-18 years with medically refractory epilepsy.

RESULTS

Strong correlations were found between actigraphy and VEEG sleep variables including night sleep period (r = 0.99), night sleep time (r = 0.96), duration of night wake time (r = 0.93) and number of significant wakings during the night (r = 0.81).

CONCLUSION

The study results validate that actigraphy is a reliable and objective clinical and research tool for evaluating sleep and wakefulness in children with epilepsy.

Waking and sleeping in the rat made obese through a high-fat hypercaloric diet

Sleep restriction leads to metabolism dysregulation and to weight gain, which is apparently the consequence of an excessive caloric intake. On the other hand, obesity is associated with excessive daytime sleepiness in humans and promotes sleep in different rodent models of obesity. Since no consistent data on the wake-sleep (WS) pattern in diet-induced obesity rats are available, in the present study the effects on the WS cycle of the prolonged delivery of a high-fat hypercaloric (HC) diet leading to obesity were studied in Sprague-Dawley rats. The main findings are that animals kept under a HC diet for either four or eight weeks showed an overall decrease of time spent in wakefulness (Wake) and a clear Wake fragmentation when compared to animals kept under a normocaloric diet. The development of obesity was also accompanied with the occurrence of a larger daily amount of REM sleep (REMS). However, the capacity of HC animals to respond to a "Continuous darkness" exposure condition (obtained by extending the Dark period of the Light-Dark cycle to the following Light period) with an increase of Sequential REMS was dampened. The results of the present study indicate that if, on one hand, sleep curtailment promotes an excess of energy accumulation; on the other hand an over-exceeding energy accumulation depresses Wake. Thus, processes underlying energy homeostasis possibly interact with those underlying WS behavior, in order to optimize energy storage.

Theoretical modelling of wakes from retractable flapping wings in forward flight

A free-wake method is used to simulate the wake from retractable, jointed wings. The method serves to complement existing experimental studies that visualise flying animal wakes. Simulated wakes are shown to be numerically convergent for a case study of the Rock Pigeon in minimum power cruising flight. The free-wake model is robust in simulating wakes for a range of wing geometries and dynamics without requiring changes to the numerical method. The method is found to be useful for providing low order predictions of wake geometries. However, it is not well suited to reconstructing 3d flowfields as solutions are sensitive to the numerical mesh node locations.

Intracranially recorded interictal spikes: relation to seizure onset area and effect of medication and time of day

OBJECTIVE

The relationship between seizures and interictal spikes remains undetermined. We analyzed intracranial EEG (icEEG) recordings to examine the relationship between the seizure onset area and interictal spikes.

METHODS

80 unselected patients were placed into 5 temporal, 4 extratemporal, and one unlocalized groups based on the location of the seizure onset area. We studied 4-h icEEG epochs, removed from seizures, from day-time and night-time during both on- and off-medication periods. Spikes were detected automatically from electrode contacts sampling the hemisphere ipsilateral to the seizure onset area.

RESULTS

There was a widespread occurrence of spikes over the hemisphere ipsilateral to the seizure onset area. The spatial distributions of spike rates for the different patient groups were different (p<0.0001, chi-square test). The area with the highest spike rate coincided with the seizure onset area only in half of the patients.

CONCLUSION

The spatial distribution of spike rates is strongly associated with the location of the seizure onset area, suggesting the presence of a distributed spike generation network, which is related to the seizure onset area.

SIGNIFICANCE

The spatial distribution of spike rates, but not the area with the highest spike rate, may hold value for the localization of the seizure onset area.