Chance and risk in epilepsy. Issue 2 (April 2020)

• Record Type: Journal Article
• Authors: Baud, Maxime O.; Proix, Timothée; Rao, Vikram R.; Schindler, Kaspar
• Is Part Of: Current opinion in neurology. Volume 33:Issue 2(2020)
• Publication Date: 2020-04
• Subjects: chronic EEG -- dynamical systems theory -- seizure cycles -- seizure dynamics -- seizure forecasting; Neurology -- Periodicals; Nervous system -- Diseases -- Periodicals; 616.805
• DOI: 10.1097/WCO.0000000000000798
• Languages: English
• ISSNs: 1473-6551

Abstract

Abstract : Purpose of review: Epilepsy is a dynamical disorder of the brain characterized by sudden, seemingly unpredictable transitions to the ictal state. When and how these transitions occur remain unresolved questions in neurology. Recent findings: Modelling work based on dynamical systems theory proposed that a slow control parameter is necessary to explain the transition between interictal and ictal states. Recently, converging evidence from chronic EEG datasets unravelled the existence of cycles of epileptic brain activity at multiple timescales – circadian, multidien (over multiple days) and circannual – which could reflect cyclical changes in a slow control parameter. This temporal structure of epilepsy has theoretical implications and argues against the conception of seizures as completely random events. The practical significance of cycles in epilepsy is highlighted by their predictive value in computational models for seizure forecasting. Summary: The canonical randomness of seizures is being reconsidered in light of cycles of brain activity discovered through chronic EEG. This paradigm shift motivates development of next-generation devices to track more closely fluctuations in epileptic brain activity that determine time-varying seizure risk. Abstract : Supplemental Digital Content is available in the text