{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T05:05:26Z","timestamp":1789794326024,"version":"4.0.1"},"reference-count":43,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001665","name":"Agence Nationale de la Recherche","doi-asserted-by":"publisher","award":["ANR\u201010\u2010IAIHU\u201006"],"award-info":[{"award-number":["ANR\u201010\u2010IAIHU\u201006"]}],"id":[{"id":"10.13039\/501100001665","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Interictal electroencephalographic (EEG) activities are generally considered asymptomatic. Pulse wave amplitude drop (PWAD) is a marker of autonomic nervous system (ANS) reactivity linked to cardiovascular risk. Generalized paroxysmal fast activity (GPFA) is a major EEG pattern in different epileptic conditions. We investigated whether GPFA, even when clinically silent, triggers ANS activation measured by PWAD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 511 GPFA events during sleep from 21 patients undergoing polysomnography. We characterized GPFA events and their association with PWAD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 511 GPFA events, 26.4% were clinically asymptomatic without PWAD (Group 1), 40.5% were clinically silent with PWAD \u2265\u200930% as the only detected sign (Group 2), and 33.1% were clinically symptomatic (Group 3). Compared to Groups 1 and 2, Group 3 events had longer duration (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.007 and\n                      <jats:italic>p<\/jats:italic>\n                      &lt; .0001), had higher heart rate variation (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001), and were more often symmetric (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001). Group 3 GPFA occurred more often in N1 sleep compared to Group 2 (32.1 vs. 18.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.004). Unexpectedly, PWAD was poorly correlated with GPFA duration (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u2009.068). Finally, Group 2 GPFA\u2010associated PWADs more closely resembled microarousal\u2010associated PWADs than apnea\/hypopnea\u2010associated PWADs in temporal profile.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>PWAD uncovers autonomic responses in most GPFA, challenging the concept that \u201cinterictal\u201d implies asymptomatic. This repetitive ANS activation raises questions about its potential long\u2010term clinical consequences. These findings support the use of pulse oximetry during video\u2010EEG to detect subclinical autonomic changes, although further studies are needed to determine their clinical significance and whether they should influence the management of interictal activities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/epi.70438","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T06:47:32Z","timestamp":1788504452000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Revisiting the concept that interictal implies asymptomatic: Pulse wave amplitude drops uncover autonomic responses during generalized paroxysmal fast activities"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5827-5678","authenticated-orcid":false,"given":"Julie","family":"L\u00e9vi\u2010Strauss","sequence":"first","affiliation":[{"name":"Assistance Publique\u2010H\u00f4pitaux de Paris (AP\u2010HP), Epilepsy Unit, Piti\u00e9\u2010Salp\u00eatri\u00e8re Hospital, D\u00e9partement M\u00e9dico\u2010Universitaire (DMU) Neurosciences Sorbonne Universit\u00e9  Paris France"},{"name":"Paris Brain Institute\u2013Institut du Cerveau, Inserm, Centre National de la Recherche Scientifique (CNRS), AP\u2010HP, Piti\u00e9\u2010Salp\u00eatri\u00e8re Hospital Sorbonne Universit\u00e9  Paris France"},{"name":"Universit\u00e9 Paris Cit\u00e9, Institut Pasteur, AP\u2010HP, Inserm, CNRS, Fondation Pour l'Audition, Institut de l'Audition, Institut Hospitalo\u2010Universitaire (IHU) reConnect  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1187-3352","authenticated-orcid":false,"given":"Valerio","family":"Frazzini","sequence":"additional","affiliation":[{"name":"Assistance Publique\u2010H\u00f4pitaux de Paris (AP\u2010HP), Epilepsy Unit, Piti\u00e9\u2010Salp\u00eatri\u00e8re Hospital, D\u00e9partement M\u00e9dico\u2010Universitaire (DMU) Neurosciences Sorbonne Universit\u00e9  Paris France"},{"name":"Paris Brain Institute\u2013Institut du Cerveau, Inserm, Centre National de la Recherche Scientifique (CNRS), AP\u2010HP, Piti\u00e9\u2010Salp\u00eatri\u00e8re Hospital Sorbonne Universit\u00e9  Paris France"},{"name":"AP\u2010HP, Electroencephalography (EEG) Unit, Department of Clinical Neurophysiology, Piti\u00e9\u2010Salp\u00eatri\u00e8re Hospital, DMU Neurosciences Sorbonne Universit\u00e9  Paris France"},{"name":"Reference Center for Rare Epilepsies, European Reference Network EpiCARE Piti\u00e9\u2010Salp\u00eatri\u00e8re Hospital  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claude","family":"Adam","sequence":"additional","affiliation":[{"name":"Assistance Publique\u2010H\u00f4pitaux de Paris (AP\u2010HP), Epilepsy Unit, Piti\u00e9\u2010Salp\u00eatri\u00e8re Hospital, D\u00e9partement M\u00e9dico\u2010Universitaire (DMU) Neurosciences Sorbonne 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