Estimation of brain network ictogenicity predicts outcome from epilepsy surgery
Nature Publishing Group: Open Access Journals - Option C
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Surgery is a valuable option for pharmacologically intractable epilepsy. However, significant post-operative improvements are not always attained. This is due in part to our incomplete understanding of the seizure generating (ictogenic) capabilities of brain networks. Here we introduce an in silico, model-based framework to study the effects of surgery within ictogenic brain networks. We find that factors conventionally determining the region of tissue to resect, such as the location of focal brain lesions or the presence of epileptiform rhythms, do not necessarily predict the best resection strategy. We validate our framework by analysing electrocorticogram (ECoG) recordings from patients who have undergone epilepsy surgery. We find that when post-operative outcome is good, model predictions for optimal strategies align better with the actual surgery undertaken than when post-operative outcome is poor. Crucially, this allows the prediction of optimal surgical strategies and the provision of quantitative prognoses for patients undergoing epilepsy surgery.
MG, MPR and JRT gratefully acknowledge the financial support of the EPSRC via grant EP/N014391/1. They further acknowledge funding from Epilepsy Research UK via grant number A1007 and the Medical Research Council via grant MR/K013998/1. The contribution of MG and JRT was generously supported by a Wellcome Trust Institutional Strategic Support Award (WT105618MA). MPR is supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust. CR and AE were supported by the Swiss National Science Foundation (grant SPUM 140332). KS is grateful for support from the Swiss National Science Foundation (grants 122010 and 155950).
Vol. 6, Article number: 29215