Limits...
Predictability of uncontrollable multifocal seizures - towards new treatment options.

Lehnertz K, Dickten H, Porz S, Helmstaedter C, Elger CE - Sci Rep (2016)

Bottom Line: Drug-resistant, multifocal, non-resectable epilepsies are among the most difficult epileptic disorders to manage.Our findings clearly indicate that epileptic networks, spanning lobes and hemispheres, underlie generation of seizures.Our proof-of-concept study is an important milestone towards new therapeutic strategies based on seizure-prediction techniques for clinical practice.

View Article: PubMed Central - PubMed

Affiliation: Department of Epileptology, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.

ABSTRACT
Drug-resistant, multifocal, non-resectable epilepsies are among the most difficult epileptic disorders to manage. An approach to control previously uncontrollable seizures in epilepsy patients would consist of identifying seizure precursors in critical brain areas combined with delivering a counteracting influence to prevent seizure generation. Predictability of seizures with acceptable levels of sensitivity and specificity, even in an ambulatory setting, has been repeatedly shown, however, in patients with a single seizure focus only. We did a study to assess feasibility of state-of-the-art, electroencephalogram-based seizure-prediction techniques in patients with uncontrollable multifocal seizures. We obtained significant predictive information about upcoming seizures in more than two thirds of patients. Unexpectedly, the emergence of seizure precursors was confined to non-affected brain areas. Our findings clearly indicate that epileptic networks, spanning lobes and hemispheres, underlie generation of seizures. Our proof-of-concept study is an important milestone towards new therapeutic strategies based on seizure-prediction techniques for clinical practice.

No MeSH data available.


Related in: MedlinePlus

Critical module combinations (carrying predictive information) for each patient.Symmetric matrix of predictive interactions between functional modules (focal (f), neighborhood (n), other (o)): each color-coded entry represents the mean relative change in synchrony obtained from averaging over all δR-values from the respective critical module combinations identified in each patient (see Fig. 3E). (A) patients with chronic intractable epilepsy (group 1; patient-codes as in Table 1); (B) control group (group 2; patient-codes as in Table 2).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4835791&req=5

f4: Critical module combinations (carrying predictive information) for each patient.Symmetric matrix of predictive interactions between functional modules (focal (f), neighborhood (n), other (o)): each color-coded entry represents the mean relative change in synchrony obtained from averaging over all δR-values from the respective critical module combinations identified in each patient (see Fig. 3E). (A) patients with chronic intractable epilepsy (group 1; patient-codes as in Table 1); (B) control group (group 2; patient-codes as in Table 2).

Mentions: Figure 4 summarizes our main findings for each patient. Among the sixteen patients with chronic intractable epilepsy (group 1), we observed ten patients with predictive indications from interactions between brain regions not related to initial ictal discharges (o–o interactions). Four patients presented with predictive f–o and one patient with predictive n–o interaction (note that a patient may contribute to more than one critical module combination). Among the twenty patients in the control group (group 2), we observed six patients each with predictive indications from interactions within the SOZ (f–f interactions) as well as from interactions between the SOZ and remote brain regions (f–o interactions). Four patients presented with predictive o–o interactions, three with predictive n–o and two with predictive f–n interactions.


Predictability of uncontrollable multifocal seizures - towards new treatment options.

Lehnertz K, Dickten H, Porz S, Helmstaedter C, Elger CE - Sci Rep (2016)

Critical module combinations (carrying predictive information) for each patient.Symmetric matrix of predictive interactions between functional modules (focal (f), neighborhood (n), other (o)): each color-coded entry represents the mean relative change in synchrony obtained from averaging over all δR-values from the respective critical module combinations identified in each patient (see Fig. 3E). (A) patients with chronic intractable epilepsy (group 1; patient-codes as in Table 1); (B) control group (group 2; patient-codes as in Table 2).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4835791&req=5

f4: Critical module combinations (carrying predictive information) for each patient.Symmetric matrix of predictive interactions between functional modules (focal (f), neighborhood (n), other (o)): each color-coded entry represents the mean relative change in synchrony obtained from averaging over all δR-values from the respective critical module combinations identified in each patient (see Fig. 3E). (A) patients with chronic intractable epilepsy (group 1; patient-codes as in Table 1); (B) control group (group 2; patient-codes as in Table 2).
Mentions: Figure 4 summarizes our main findings for each patient. Among the sixteen patients with chronic intractable epilepsy (group 1), we observed ten patients with predictive indications from interactions between brain regions not related to initial ictal discharges (o–o interactions). Four patients presented with predictive f–o and one patient with predictive n–o interaction (note that a patient may contribute to more than one critical module combination). Among the twenty patients in the control group (group 2), we observed six patients each with predictive indications from interactions within the SOZ (f–f interactions) as well as from interactions between the SOZ and remote brain regions (f–o interactions). Four patients presented with predictive o–o interactions, three with predictive n–o and two with predictive f–n interactions.

Bottom Line: Drug-resistant, multifocal, non-resectable epilepsies are among the most difficult epileptic disorders to manage.Our findings clearly indicate that epileptic networks, spanning lobes and hemispheres, underlie generation of seizures.Our proof-of-concept study is an important milestone towards new therapeutic strategies based on seizure-prediction techniques for clinical practice.

View Article: PubMed Central - PubMed

Affiliation: Department of Epileptology, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.

ABSTRACT
Drug-resistant, multifocal, non-resectable epilepsies are among the most difficult epileptic disorders to manage. An approach to control previously uncontrollable seizures in epilepsy patients would consist of identifying seizure precursors in critical brain areas combined with delivering a counteracting influence to prevent seizure generation. Predictability of seizures with acceptable levels of sensitivity and specificity, even in an ambulatory setting, has been repeatedly shown, however, in patients with a single seizure focus only. We did a study to assess feasibility of state-of-the-art, electroencephalogram-based seizure-prediction techniques in patients with uncontrollable multifocal seizures. We obtained significant predictive information about upcoming seizures in more than two thirds of patients. Unexpectedly, the emergence of seizure precursors was confined to non-affected brain areas. Our findings clearly indicate that epileptic networks, spanning lobes and hemispheres, underlie generation of seizures. Our proof-of-concept study is an important milestone towards new therapeutic strategies based on seizure-prediction techniques for clinical practice.

No MeSH data available.


Related in: MedlinePlus