Journal
PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA
Volume 117, Issue 20, Pages 11048-11058Publisher
NATL ACAD SCIENCES
DOI: 10.1073/pnas.1922084117
Keywords
focal epilepsy; seizure dynamics; functional connectivity; within-patient variability; intracranial EEG
Categories
Funding
- Wellcome Trust [208940/Z/17/Z, 210109/Z/18/Z]
- Wellcome Trust [210109/Z/18/Z, 208940/Z/17/Z] Funding Source: Wellcome Trust
- MRC [MR/R005427/1, MR/J013250/1] Funding Source: UKRI
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Personalized medicine requires that treatments adapt to not only the patient but also changing factors within each individual. Although epilepsy is a dynamic disorder characterized by pathological fluctuations in brain state, surprisingly little is known about whether and how seizures vary in the same patient. We quantitatively compared within-patient seizure network evolutions using intracranial electroencephalographic (iEEG) recordings of over 500 seizures from 31 patients with focal epilepsy (mean 16.5 seizures per patient). In all patients, we found variability in seizure paths through the space of possible network dynamics. Seizures with similar pathways tended to occur closer together in time, and a simple model suggested that seizure pathways change on circadian and/or slower timescales in the majority of patients. These temporal relationships occurred independent of whether the patient underwent antiepileptic medication reduction. Our results suggest that various modulatory processes, operating at different timescales, shape within-patient seizure evolutions, leading to variable seizure pathways that may require tailored treatment approaches.
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