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Purpose: Ictal electrographic changes were analyzed on intracranial electrocorticography (ECoG) in children with medically refractory epileptic spasms to assess the dynamic changes of ictal discharges associated with spasms and their relation to interictal epileptiform activity and neuroimaging findings.

Methods: We studied a consecutive series of 15 children (age 0.4 to 13 years; nine girls) with clusters of epileptic spasms recorded on prolonged intracranial subdural ECoG recordings, which were being performed for subsequent cortical resection, and in total, 62 spasms were analyzed by using quantitative methods.

Results: Spasms were associated with either a “leading” spike followed by fast‐wave bursts (type I: 42 events analyzed quantitatively) or fast‐wave bursts without a “leading” spike (type II: 20 events analyzed quantitatively). Twenty‐three of the 42 type I spasms but none of the 20 type II spasms were …