Sawtooth Delta of the Thalamus: A Physiological Variant and the Intracranial Generator of Rapid-Eye Movement Sleep Sawtooth Waves

Division

South Atlantic

Hospital

Trident Medical Center

Document Type

Manuscript

Publication Date

4-7-2025

Keywords

Closed-loop neurostimulation, Epilepsy, Epilepsy surgery, Intracranial EEG, Physiological variants, Rapid eye-movement sleep, Stereoelectroencephalography, Thalamus

Disciplines

Medicine and Health Sciences | Nervous System Diseases | Neurology | Surgery

Abstract

OBJECTIVE: To describe slow wave activity in the thalamic centro-median nucleus (CMN) region during rapid eye-movement (REM) sleep and its relation to the scalp EEG sawtooth waves.

METHODS: Five (5) patients undergoing stereo-electroencephalography were implanted in the CMN. Sleep was scored using the concurrent scalp EEG, eye-movement artifacts in Fp1, Fp2, F7, and F8, and chin EMG.

RESULTS: In the CMN region, blocks of successive delta waves assuming a sawtooth morphology were observed, presenting with high specificity for REM (p

CONCLUSIONS: SDT is a physiological variant, specific to REM sleep, manifesting with two morphologically distinct subtypes, one of them generating REM sawtooth waves on scalp.

SIGNIFICANCE: Discriminating between this physiological variant and actual ictal neurophysiological signatures is imperative for efficient therapeutic CMN neurostimulation.

Publisher or Conference

Clinical Neurophysiology

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