We report four adult patients who had thalamic lesions and lateralized or generalized spike wave discharges (SWDs). The first two patients also had. cortical lesions. The role of the cortex and thalamus in the generation of SWDs is discussed. The third patient had a history of idiopathic generalized epilepsy (IGE) with intractable seizures. The last patient had partial seizures and absences. The coexistence of IGE with refractory focal epilepsy and the relation with thalamic lesions are discussed. (C) 2009 Elsevier B.V. All rights reserved.