Discharges in ventromedial frontal cortex during absence spells

Neural mechanisms of conscious attention require thalamic control of widespread cortical networks. Absence spells involve a momentary loss of voluntary control of attention, during which the person is inactive and unresponsive. The spike–wave seizure discharges of these spells rapidly engage both cerebral hemispheres in the classic sign of a “generalized” seizure. Animal evidence suggests that spike–wave seizures are caused by a disruption of thalamic circuitry, with extensive spread to cortex through thalamocortical propagation. We applied advanced methods of electrical source analysis to dense array (256-channel) electroencephalographic recordings of spike–wave discharges of absence spells. Neither the onset nor the spread of these seizures is generalized. Rather, the slow waves of the discharges are restricted to frontotemporal networks, and the spikes represent a highly localized and stereotyped progression of electrophysiological activity in ventromedial frontal networks. Given the current knowledge of the neurophysiology of absence seizures, this specificity of the frontal cortical discharges suggests the hypothesis that absence spells are associated with pathology in a circuit comprising ventromedial frontal cortex, rostral thalamic reticular nucleus, and limbic nuclei of the thalamus. Disrupted in absence, this circuit appears to regulate important aspects of the voluntary control of conscious attention.