• Pia De Stefano, Margherita Carboni, Deborah Pugin, Margitta Seeck, and Serge Vulliémoz.
• EEG & Epilepsy Unit, Neurology Clinic, Department of Clinical Neurosciences, Geneva University Hospitals, 4, Rue Gabrielle Perret-Gentil, 1205 Geneva, Switzerland. Electronic address: Pia.destefano@hcuge.ch.
• Resuscitation. 2020 Oct 1; 155: 143-151.

AimGeneralized periodic discharge (GPD) is an EEG pattern of poor neurological outcome, frequently observed in comatose patients after cardiac arrest. The aim of our study was to identify the neuronal network generating ≤2.5 Hz GPD using EEG source localization and connectivity analysis.MethodsWe analyzed 40 comatose adult patients with anoxic-ischemic encephalopathy, who had 19 channel-EEG recording. We computed electric source analysis based on distributed inverse solution (LAURA) and we estimated cortical activity in 82 atlas-based cortical brain regions. We applied directed connectivity analysis (Partial Directed Coherence) on these sources to estimate the main drivers.ResultsSource analysis suggested that the GPD are generated in the cortex of the limbic system in the majority of patients (87.5%). Connectivity analysis revealed main drivers located in thalamus and hippocampus for the large majority of patients (80%), together with important activation also in amygdala (70%).ConclusionsWe hypothesize that the anoxic-ischemic dysfunction, leading to hyperactivity of the thalamo-cortical (limbic presumably) circuit, can result in an oscillatory thalamic activity capable of inducing periodic cortical (limbic, mostly medial-temporal and orbitofrontal) discharges, similarly to the case of generalized rhythmic spike-wave discharge in convulsive or non-convulsive status epilepticus.Copyright © 2020 The Author(s). Published by Elsevier B.V. All rights reserved.

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