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Summary   Objective  Spike foci in benign epilepsy with centrotemporal spikes ( BECTS ) are related to seizure semiologies, but this relationship is inconspicuous in Panayiotopoulos syndrome ( PS ). We analyzed spike‐associated high‐frequency activity ( HFA ) and its relationship to spike foci in the electroencephalograms ( EEG s) of patients with  BECTS  and  PS  in order to elucidate the pathophysiology of these epileptic syndromes.    Methods  In 35 patients with  BECTS  and 29 with  PS , focal spikes in scalp sleep  EEG s were first classified by clustering according to their characteristics, including shape and distribution. For each patient, three or fewer spike clusters were investigated by time‐frequency spectral analysis and single‐dipole analysis using a realistic three‐dimensional head model to explore the relationships between the presence or absence of spike‐associated  HFA  and the distribution of estimated spike sources.    Results  A total of 159 spike clusters were analyzed (96 in  BECTS  and 63 in  PS ).  HFA  was detected in 73 spike clusters (76.0%) in  BECTS  and 37 (58.7%) in  PS , with a significant difference in the proportion of spike clusters with  HFA  (p = 0.024 by Fisher's exact test). In  BECTS , spikes had relatively uniform distributions, but the proportion of spikes with associated  HFA  was significantly higher in the spike group with dipoles in the perirolandic areas (42 of 49) than in that with dipoles outside of the perirolandic areas (23 of 36; p = 0.037). In  PS , The proportion of spikes with associated  HFA  was significantly higher in the spike group with dipoles in the occipital lobes (20 of 26) than in that with dipoles outside of the occipital lobes (13 of 33; p = 0.020).    Significance  The proportion of spike‐associated  HFA  was higher in  BECTS  than in  PS . Particular pathophysiological meaning was indicated in spikes with dipoles in the perirolandic areas in  BECTS  and in spikes with dipoles in the occipital lobes in  PS  owing to the high proportions of spike‐associated  HFA  in these areas.

A study on spike focus dependence of high‐frequency activity in idiopathic focal epilepsy in childhood