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We studied the association between the topography of absence onset and the ictal automatisms, and the topographic correlation between FSWDs and GSWDs and their respective behavior during hyperventilation and the different states of phasic and nonphasic non\u2013rapid eye movement (NREM) sleep. GSWDs were considered as of \u201cfocal\u201d onset if a lead\u2010in could be visibly recognized at a paper speed of 60\u2003mm\/s, and were classified by their topography.<\/jats:p><jats:p><jats:bold>Key Findings:\u2002<\/jats:bold> (1) Multifocal absences occurred in 10 children; anterior onset was noted in 81 absences (73.6%) from 12 children and posterior in 18 (16.4%) from 7 children; there was no association between topography of absence onset and ictal automatisms; (2) FSWDs occurred in 85% of children and were multifocal in 73% of them; 85% of FSWDs were anterior and 14% posterior; (3) there was good topographic association between FSWDs and the leading spike of GSWDs of \u201cfocal\u201d onset in all children with FSWDs; (4) both FSWDs and GSWDs increased during hyperventilation; (5) FSWDs occurred mainly during noncyclical NREM sleep and during periods of reduced vigilance of cyclical NREM sleep, whereas GSWDs occurred during the periods of enhanced vigilance of NREM sleep; GSWDs occurred significantly more frequently than FSWDs at the transition from reduced to enhanced vigilance of NREM sleep.<\/jats:p><jats:p><jats:bold>Significance:\u2002<\/jats:bold> Our findings suggest that in CAE focal EEG paroxysms reflect a system of multifocal <jats:italic>nonlocalizing<\/jats:italic> electrically unstable cortical areas that under the facilitatory influence of exogenous or endogenous factors like sleep instability can foster a corticothalamic response of sufficient strength to generate 3\u2010Hz GSWDs that are conditionally sustainable and potentially ictal. FSWDs can be viewed as <jats:italic>incomplete forms<\/jats:italic> of the GSWDs; together they define the EEG identity of idiopathic \u201cgeneralized\u201d epileptogenesis.<\/jats:p>","DOI":"10.1111\/j.1528-1167.2012.03424.x","type":"journal-article","created":{"date-parts":[[2012,2,23]],"date-time":"2012-02-23T17:59:38Z","timestamp":1330019978000},"page":"840-849","source":"Crossref","is-referenced-by-count":37,"title":["Focal and generalized EEG paroxysms in childhood absence epilepsy: Topographic associations and distinctive behaviors during the first cycle of non\u2010REM sleep"],"prefix":"10.1111","volume":"53","author":[{"given":"Michalis","family":"Koutroumanidis","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitrios","family":"Tsiptsios","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vasileios","family":"Kokkinos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George K.","family":"Kostopoulos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2012,2,23]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.106.2.122"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2008.12.011"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0013-4694(74)90031-5"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/155005949903000306"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2011.03049.x"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2010.02522.x"},{"key":"e_1_2_7_8_1","first-page":"100","article-title":"Reading epilepsy: clinical and electroencephalographic studies of a new syndrome","volume":"81","author":"Bickford RG","year":"1956","journal-title":"Trans Am Neurol Assoc"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/0013-4694(81)90031-6"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2009.02110.x"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.47.3.802"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1965.00470030003001"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.braindev.2004.01.008"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eplepsyres.2008.11.011"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2009.02198.x"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2008.01950.x"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.seizure.2009.04.004"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1157.1989.tb05316.x"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eplepsyres.2005.11.018"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.13.11.959"},{"key":"e_1_2_7_21_1","first-page":"1","article-title":"Epilepsy and 3 per second spike and wave rhythms. 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