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Summary  We investigated the relationship between the scalp distribution of fast (40–150 Hz) oscillations ( FO s) and epileptogenic lesions in West syndrome ( WS ) and related disorders. Subjects were 9 pediatric patients with surgically confirmed structural epileptogenic pathology (age at initial electroencephalogram [ EEG ] recording: mean 7.1 months, range 1–22 months). The diagnosis was  WS  in 7 patients, Ohtahara syndrome in 1, and a transitional state from Ohtahara syndrome to  WS  in the other. In the scalp  EEG  data of these patients, we conservatively detected  FO s, and then examined the distribution of  FO s. In five patients, the scalp distribution of  FO s was consistent and concordant with the lateralization of cerebral pathology. In another patient,  FO s were consistently dominant over the healthy cerebral hemisphere, and the  EEG  was relatively low in amplitude over the pathological atrophic hemisphere. In the remaining 3 patients, the dominance of  FO s was inconsistent and, in 2 of these patients, the epileptogenic hemisphere was reduced in volume, which may result from atrophy or hypoplasia. The correspondence between the scalp distribution of  FO s and the epileptogenic lesion should be studied, taking the type of lesion into account. The factors affecting scalp  FO s remain to be elucidated.

Complex observation of scalp fast (40–150 Hz) oscillations in West syndrome and related disorders with structural brain pathology