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Journal of Child Neurology
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Midline Foci of Epileptiform Activity in Children and Neonates

Richard A. Fischer, MD

Division of Neurology, the Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, the University of Pennsylvania School of Medicine, Philadelphia, PA

Robert R. Clancy, MD

Division of Neurology, the Children's Hospital of Philadelphia,, Departments of Neurology and Pediatrics, the University of Pennsylvania School of Medicine, Philadelphia, PA

We report the clinical and electroencephalographic (EEG) correlates of focal potentially epileptogenic discharge arising from midline sagittal vertices (Fz, Cz , Pz) in 21 children prospectively identified from among 7,051 consecutive EEGs recorded during a 27-month period. The patients range in age from neonates to 13 years. EEGs were obtained during evaluations for solitary or recurrent seizures (17/21), attention deficit disorder (2/21), psychomotor retardation (1/21), and headache (1/21). Clinical seizure types were diverse and included simple partial (5/17), complex partial (2/17), generalized tonic-clonic (4/17), mixed (2/17), and neonatal (4/17). The majority (13/21) of patients had an idetifiable etiology for their disorder; CT scans verified mass lesions in two patients. Midline epileptogenic foci were present during wakefulness in 14 of 17 older children and restricted to sleep in the others. Sleep states were indeterminate in the four neonates. Midline foci were exquisitely confined to Fz, Cz, and/or Pz in 6 of 17 older children and would have been entirely missed by a recording montage that did not include vertex electrodes. In five other children, midline foci spread preferentially to the adjacent central-parietal regions and closely resembled the appearance of benign rolandic foci in the longitudinal EEG montages, a potentially serious cause of EEG misinterpretation in view of the high incidence of neuropathology in this patient group. (J Child Neurol 1987;2:224-228).

Journal of Child Neurology, Vol. 2, No. 3, 224-228 (1987)
DOI: 10.1177/088307388700200310
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