**5.2 Ictal EEG**

The first described ictal patterns are characterized by a quite monomorphic sequence of rhythmic sharp waves or spikes without significant post-ictal slowing [91, 114]. In 1990, Gutierrez et al. described an ictal event with speech arrest only characterized by a short train of ictal alpha activity, and then two multiple spikes and wave complexes originated from the left centrotemporal region followed by marked attenuation of the left hemispheric background [115]. Subclinical rhythmic discharges of spike and wave in the centrotemporal region have been documented by several authors in RE [116, 117]. Saint-Martin et al. in 2001 described a series of patients presenting with typical and also atypical ictal manifestations such as falls, negative myoclonus and observed that positive motor phenomenon correlated to the spike component preceding a negative motor phenomenon, correlated with the slow-wave component of the spike and wave complex [118].

Capovilla et al. recorded 34 seizures in 30 patients with RE and described four electrographic seizure patterns thus emphasizing that ictal pattern for RE is not unique [116]:


Ictal EEG source analysis of 3 patients with RE demonstrated the activation of the opercula-insular area, time-locked to the contralateral focal myoclonic jerks [119].
