OBJECTIVE Encephalopathy with Status Epilepticus during slow Sleep (ESES) is a syndrome where neurocognitive impairment correlates with multifocal Electroencephalography (EEG) spikes increasing abruptly at sleep onset. Demonstration of a focal onset could provide important clues to unravel the mechanisms underlying the condition, but until know it has not been established. METHODS We studied epileptic dynamics at sleep onset to assess its focal or diffuse features in five patients with perinatal thalamic hemorrhages lateralized to one hemisphere, using high resolution EEG. RESULTS Dynamical functional connectivity revealed the information flow in the epileptic network and identified primary sources of outflow, equated with cortical spike sources. We found that spikes with important activation originate in restricted cortical areas of the hemisphere with the lesion, spreading widely and quickly at onset of N2 sleep stage. CONCLUSIONS Perinatal thalamic lesions have the potential to induce, years later, a regional onset of epileptic activity with features of ESES in a cortex without apparent structural lesion. Most widespread spike activity in the scalp results from secondary propagation. SIGNIFICANCE Perinatal thalamic lesions produce ESES with focal onset in a restricted cortical area of the hemisphere with the lesion, and prominent secondary propagation.

中文翻译：

---

单侧丘脑病变后缓慢睡眠期间癫痫持续状态脑病 (ESES) 中睡眠发作时癫痫活动的时空动态

目标缓慢睡眠期间癫痫持续状态 (ESES) 脑病是一种综合征，其中神经认知障碍与多焦脑电图 (EEG) 峰值在睡眠开始时突然增加有关。证明局灶性发作可以提供重要的线索来解开该病症的潜在机制，但直到知道它尚未确定为止。方法 我们研究了睡眠开始时的癫痫动力学，以使用高分辨率 EEG 评估 5 名患有一侧半球的围产期丘脑出血患者的局灶性或弥漫性特征。结果动态功能连接揭示了癫痫网络中的信息流，并确定了流出的主要来源，等同于皮质尖峰源。我们发现具有重要激活的尖峰起源于病变半球的受限皮质区域，在 N2 睡眠阶段开始时广泛而迅速地传播。结论 围产期丘脑病变有可能在多年后诱发癫痫活动的区域性发作，在没有明显结构性病变的皮质中具有 ESES 的特征。头皮中最普遍的尖峰活动来自二次繁殖。意义 围产期丘脑病变产生 ESES，局灶性发作在病变半球的受限皮质区域，并有明显的继发性传播。癫痫活动的区域性发作，具有皮层中 ESES 的特征，没有明显的结构性病变。头皮中最普遍的尖峰活动来自二次繁殖。意义 围产期丘脑病变产生 ESES，局灶性发作在病变半球的受限皮质区域，并有明显的继发性传播。癫痫活动的区域性发作，具有皮层中 ESES 的特征，没有明显的结构性病变。头皮中最普遍的尖峰活动来自二次繁殖。意义 围产期丘脑病变产生 ESES，局灶性发作在病变半球的受限皮质区域，并有明显的继发性传播。