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Rare Left Frontocentral Spike-Wave

Rare left frontocentral spike and wave discharges are observed in specific epileptic conditions, often indicating focal onset activity that may evolve into generalized seizures. These discharges are characterized by rhythmic spike and wave patterns originating in the left frontocentral regions, sometimes with subtle lateralized onset, and can be associated with clinical symptoms such as behavioral arrest, staring, or automatisms In one case, a seizure began with a second of rhythmic spikes best seen over the left frontocentral regions, with simultaneous but less well-formed spikes over the left anterior temporal region, classified as a left anterior quadrant onset seizure

Such discharges may be part of a broader pattern of epileptiform activity, including atypical epileptiform discharges with focal onset and offset, as seen in juvenile absence epilepsy where generalized spike-wave paroxysms begin in the left frontal region In some instances, these discharges are not purely generalized but arise from a focal epileptogenic zone, such as in patients with focal cortical dysplasia or gliomas, where the epileptiform activity may trigger generalized spike-wave discharges For example, a 50-year-old woman with a left central sulcus cortical dysplasia exhibited both focal motor seizures and generalized absence seizures, with EEG-fMRI showing distinct neuronal networks for focal versus generalized discharges

Additionally, left frontocentral spike and wave discharges may be associated with secondary generalization. A 20-year-old man with frequent absence-like seizures and a history of transient left hemiplegia after seizure clusters showed 3 Hz diffuse spike-and-slow-wave complexes predominantly in the frontal area, which could be triggered by hyperventilation and sleep In another case, a patient with a left frontal brain abscess history demonstrated pseudo bilateral synchrony in EEG, where bifrontal polyspike-wave discharges appeared synchronous but revealed focal sharp wave discharges involving the F3 electrode, indicating underlying left frontal encephalomalacia

These findings suggest that rare left frontocentral spike and wave discharges may represent focal onset generalized absence seizures, particularly when associated with structural brain lesions or abnormal metabolic activity, and may require targeted evaluation with advanced imaging and electrophysiological techniques such as magnetoencephalography or ictal SPECT