A new hypothesis is advanced concerning the pathomechanism of generalized epilepsy associated with spike-wave patterns. Spike wave (SW) attacks originate at the labile borderline between waking and sleep, c.q. REM and non-REM during minor fluctuations of the level of wakefulness, when changes inducing waking are followed rebound-like by changes inducing sleep. Thus, the dynamic properties of this critical zone are important for the understanding of the mechanism of SW attacks. Even in the absence of epilepsy, the micro-oscillations of the depth of sleep have properties that can be explained by interaction between reciprocal inductions of the sleep-wake system. The process of falling asleep originates in response to influx of external sensory stimuli due to rebound in the sleep system. As the consequence of reciprocal induction interaction of the sleep-wake system, the external stimuli become sleep-inducing. This explains all EEG synchronizations that can be precipitated by sensory stimuli, and the synchronization reaction of the type of the K complex is interpreted as a 'building-stone' of the falling-asleep process which comprises all the sleep induction processes. The many resemblances between K complex and SW-pattern are pointed out. The SW paroxysms are interpreted as an epileptic 'caricature' of the elements of sleep induction reflected in the K complex, and generalized epilepsy with SW patterns as an epileptic disorder of the function of the sleep-induction system. This hypothesis solves several contradictions in our knowledge of generalized attacks with SW patterns, and may constitute a biologically oriented concept for further research. An attempt is made to use this hypothesis to explain certain properties of generalized attacks with SW patterns such as genetic determination, age-dependence, the relations to the sleep-waking cycle, functional-anatomical properties and the electric and clinical symptoms of the attacks.
|Number of pages||21|
|Publication status||Published - Jan 1 1980|
ASJC Scopus subject areas
- Clinical Neurology