Reconsidering Network Mechanisms in Absence Seizures: Unhitching the Wave Cart From the Spike Horse

Spike-Wave Discharges in Absence Epilepsy: Segregation of Electrographic Components Reveals Distinct Pathways of Seizure Activity Terlau J, Yang JW, Khastkhodaei Z, et al. J Physiol (Lond.). 2020;598(12):2397-2414. Spike and wave discharges (SWDs) are the electrographic hallmark of absence seizures and the major diagnostic criterion for childhood absence epilepsy (CAE). In a widely accepted scheme, the alternating sequence of spikes and waves reflects an iterative progression of neuronal excitation during the spike component and post-excitatory silence during the wave component. Here, we challenge this view by showing that these two components are not necessarily coupled. In a genetic rat model of CAE, self-contained waves occurred in motor cortex in synchrony with SWDs in the somatosensory system during blockade of afferent input from the thalamus. Current source density analyses of multisite local field potentials (LFPs) revealed layer-specific activity, in which thalamic inputs induced a sequence of cellular-synaptic events underlying the spike component, while intracortical oscillations generated the wave component. These findings indicate novel principles of SWDs, where oscillatory cortical waves provide adequate time windows for integration of thalamocortical inputs and feedback responses during generation of seizure activity.