ESES may be the result of a secondary bilateral synchrony ESES may be the result of a secondary bilateral synchrony. The focal motor seizure is a common type of seizure, and focal epileptiform activity is usually seen during wakefulness and REM sleep. This EEG can sometimes simulate benign focal epilepsy syndrome such as epilepsy with centro-temporal spikes. The duration of ESES and the localization of focal epileptiform activity play major roles in cognitive dysfunction, suggesting that the clinical features in ESES result from a localized disruption of EEG activity caused by focal epileptic activity during slow sleep. Spike-wave activity less than 85% during NREM sleep was correlated with a decrease in cognitive impairment.139,140 Source: Epileptic Encephalopathy, Atlas of Pediatric EEG Citation: Laoprasert P. Atlas of Pediatric EEG; 2011 Available at: https://neurology.mhmedical.com/DownloadImage.aspx?image=/data/books/1042/lao001_fig_07-67.gif&sec=59079799&BookID=1042&ChapterSecID=59078729&imagename= Accessed: January 13, 2018 Copyright © 2018 McGraw-Hill Education. All rights reserved