Search

A lot of mileage has been made recently on the long and winding road toward seizure forecasting. Here we briefly review some selected milestones passed along the way, which were discussed at the International Conference for Technology and Analysis of Seizures-ICTALS 2022-convened at the University of Bern, Switzerland. Major impetus was gained recently from wearable and implantable devices that record not only electroencephalography, but also data on motor behavior, acoustic signals, and various signals of the autonomic nervous system. This multimodal monitoring can be performed for ultralong timescales covering months or years. Accordingly, features and metrics extracted from these data now assess seizure dynamics with a greater degree of completeness. Most prominently, this has allowed the confirmation of the long-suspected cyclical nature of interictal epileptiform activity, seizure risk, and seizures. The timescales cover daily, multi-day, and yearly cycles. Progress has also been fueled by approaches originating from the interdisciplinary field of network science. Considering epilepsy as a large-scale network disorder yielded novel perspectives on the pre-ictal dynamics of the evolving epileptic brain. In addition to discrete predictions that a seizure will take place in a specified prediction horizon, the community broadened the scope to probabilistic forecasts of a seizure risk evolving continuously in time. This shift of gears triggered the incorporation of additional metrics to quantify the performance of forecasting algorithms, which should be compared to the chance performance of constrained stochastic null models. An imminent task of utmost importance is to find optimal ways to communicate the output of seizure-forecasting algorithms to patients, caretakers, and clinicians, so that they can have socioeconomic impact and improve patients' well-being., (© 2023 The Authors. Epilepsia published by Wiley Periodicals LLC on behalf of International League Against Epilepsy.)

Epilepsy is now conceptualized as a network disease. The epileptic brain network comprises structurally and functionally connected cortical and subcortical brain regions - spanning lobes and hemispheres -, whose connections and dynamics evolve in time. With this concept, focal and generalized seizures as well as other related pathophysiological phenomena are thought to emerge from, spread via, and be terminated by network vertices and edges that also generate and sustain normal, physiological brain dynamics. Research over the last years has advanced concepts and techniques to identify and characterize the evolving epileptic brain network and its constituents on various spatial and temporal scales. Network-based approaches further our understanding of how seizures emerge from the evolving epileptic brain network, and they provide both novel insights into pre-seizure dynamics and important clues for success or failure of measures for network-based seizure control and prevention. In this review, we summarize the current state of knowledge and address several important challenges that would need to be addressed to move network-based prediction and control of seizures closer to clinical translation., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Transcutaneous auricular vagus nerve stimulation (taVNS) is a novel non-invasive brain stimulation technique considered as a potential supplementary treatment option for subjects with refractory epilepsy. Its exact mechanism of action is not yet fully understood. We developed an examination schedule to probe for immediate taVNS-induced modifications of large-scale epileptic brain networks and accompanying changes of cognition and behaviour. In this prospective trial, we applied short-term (1 h) taVNS to 14 subjects with epilepsy during a continuous 3-h EEG recording which was embedded in two standardized neuropsychological assessments. From these EEG, we derived evolving epileptic brain networks and tracked important topological, robustness, and stability properties of networks over time. In the majority of investigated subjects, taVNS induced measurable and persisting modifications in network properties that point to a more resilient epileptic brain network without negatively impacting cognition, behaviour, or mood. The stimulation was well tolerated and the usability of the device was rated good. Short-term taVNS has a topology-modifying, robustness- and stability-enhancing immediate effect on large-scale epileptic brain networks. It has no detrimental effects on cognition and behaviour. Translation into clinical practice requires further studies to detail knowledge about the exact mechanisms by which taVNS prevents or inhibits seizures.

Previous research has indicated that temporal changes of centrality of specific nodes in human evolving large-scale epileptic brain networks carry information predictive of impending seizures. Centrality is a fundamental network-theoretical concept that allows one to assess the role a node plays in a network. This concept allows for various interpretations, which is reflected in a number of centrality indices. Here we aim to achieve a more general understanding of local and global network reconfigurations during the pre-seizure period as indicated by changes of different node centrality indices. To this end, we investigate-in a time-resolved manner-evolving large-scale epileptic brain networks that we derived from multi-day, multi-electrode intracranial electroencephalograpic recordings from a large but inhomogeneous group of subjects with pharmacoresistant epilepsies with different anatomical origins. We estimate multiple centrality indices to assess the various roles the nodes play while the networks transit from the seizure-free to the pre-seizure period. Our findings allow us to formulate several major scenarios for the reconfiguration of an evolving epileptic brain network prior to seizures, which indicate that there is likely not a single network mechanism underlying seizure generation. Rather, local and global aspects of the pre-seizure network reconfiguration affect virtually all network constituents, from the various brain regions to the functional connections between them.

We study patterns of partial synchronization in a network of FitzHugh-Nagumo oscillators with empirical structural connectivity measured in human subjects. We report the spontaneous occurrence of synchronization phenomena that closely resemble the ones seen during epileptic seizures in humans. In order to obtain deeper insights into the interplay between dynamics and network topology, we perform long-term simulations of oscillatory dynamics on different paradigmatic network structures: random networks, regular nonlocally coupled ring networks, ring networks with fractal connectivities, and small-world networks with various rewiring probability. Among these networks, a small-world network with intermediate rewiring probability best mimics the findings achieved with the simulations using the empirical structural connectivity. For the other network topologies, either no spontaneously occurring epileptic-seizure-related synchronization phenomena can be observed in the simulated dynamics, or the overall degree of synchronization remains high throughout the simulation. This indicates that a topology with some balance between regularity and randomness favors the self-initiation and self-termination of episodes of seizure-like strong synchronization.

Debates on six controversial topics on the network theory of epilepsy were held during two debate sessions, as part of the International Conference for Technology and Analysis of Seizures, 2019 (ICTALS 2019) convened at the University of Exeter, UK, September 2-5 2019. The debate topics were (1) From pathologic to physiologic: is the epileptic network part of an existing large-scale brain network? (2) Are micro scale recordings pertinent for defining the epileptic network? (3) From seconds to years: do we need all temporal scales to define an epileptic network? (4) Is it necessary to fully define the epileptic network to control it? (5) Is controlling seizures sufficient to control the epileptic network? (6) Does the epileptic network want to be controlled? This article, written by the organizing committee for the debate sessions and the debaters, summarizes the arguments presented during the debates on these six topics., Competing Interests: Declaration of Competing Interest HZ has a grant award from the NIH (USA) on network analysis for epilepsy surgery, and is named as an inventor on patents for monitoring and modulating human brain activity., (Copyright © 2020 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)

Extreme events occur in a variety of natural, technical, and societal systems and often have catastrophic consequences. Their low-probability, high-impact nature has recently triggered research into improving our understanding of generating mechanisms, providing early warnings as well as developing control strategies. For the latter to be effective, knowledge about dynamical resistance of a system prior to an extreme event is of utmost importance. Here we introduce a novel time-series-based and non-perturbative approach to efficiently monitor dynamical resistance and apply it to high-resolution observations of brain activities from 43 subjects with uncontrollable epileptic seizures. We gain surprising insights into pre-seizure dynamical resistance of brains that also provide important clues for success or failure of measures for seizure prevention. The novel resistance monitoring perspective advances our understanding of precursor dynamics in complex spatio-temporal systems with potential applications in refining control strategies.

Epilepsy is a common disorder characterized by recurrent seizures. An overwhelming majority of people with epilepsy regard the unpredictability of seizures as a major issue. More than 30 years of international effort have been devoted to the prediction of seizures, aiming to remove the burden of unpredictability and to couple novel, time-specific treatment to seizure prediction technology. A highly influential review published in 2007 concluded that insufficient evidence indicated that seizures could be predicted. Since then, several advances have been made, including successful prospective seizure prediction using intracranial EEG in a small number of people in a trial of a real-time seizure prediction device. In this Review, we examine advances in the field, including EEG databases, seizure prediction competitions, the prospective trial mentioned and advances in our understanding of the mechanisms of seizures. We argue that these advances, together with statistical evaluations, set the stage for a resurgence in efforts towards the development of seizure prediction methodologies. We propose new avenues of investigation involving a synergy between mechanisms, models, data, devices and algorithms and refine the existing guidelines for the development of seizure prediction technology to instigate development of a solution that removes the burden of the unpredictability of seizures.

Pharmaco-electroencephalography (pharmaco-EEG) has never gained great popularity in epilepsy research. Nevertheless, the electroencephalogram (EEG) is the most important neurological examination technique in this patient population. Development and investigation of antiepileptic drugs (AEDs) involves EEG for diagnosis and outcome evaluation. In contrast to the common use of the EEG for documenting the effect of AEDs on the presence of interictal epileptiform activities or seizures, quantitative analysis of drug responses in the EEG are not yet standard in pharmacological studies. We provide an overview of dedicated pharmaco-EEG studies with AEDs in humans. A systematic search in PubMed yielded 43 articles, which were reviewed for their relevance. After excluding studies according to our exclusion criteria, nine studies remained. These studies plus the retrieved references from the bibliographies of the identified studies yielded 37 studies to be included in the review. The most prominent method in pharmaco-EEG research for AEDs was analysis of the frequency content in response to drug intake, often with quantitative methods such as spectral analysis. Despite documenting the effect of the drug on brain activity, some studies were conducted in order to document treatment response, detect neurotoxic effects, and measure reversibility of AED-induced changes. There were some attempts to predict treatment response or side effects. We suggest that pharmaco-EEG deserves more attention in AED research, specifically because the newest drugs and techniques have not yet been subject to investigation.

We investigate the temporal and spatial variability of the importance of brain regions in evolving epileptic brain networks. We construct these networks from multiday, multichannel electroencephalographic data recorded from 17 epilepsy patients and use centrality indices to assess the importance of brain regions. Time-resolved indications of highest importance fluctuate over time to a greater or lesser extent, however, with some periodic temporal structure that can mostly be attributed to phenomena unrelated to the disease. In contrast, relevant aspects of the epileptic process contribute only marginally. Indications of highest importance also exhibit pronounced alternations between various brain regions that are of relevance for studies aiming at an improved understanding of the epileptic process with graph-theoretical approaches. Nonetheless, these findings may guide new developments for individualized diagnosis, treatment, and control.

We investigate the relative merit of phase-based methods-mean phase coherence, unweighted and weighted phase lag index-for estimating the strength of interactions between dynamical systems from empirical time series which are affected by common sources and noise. By numerically analyzing the interaction dynamics of coupled model systems, we compare these methods to each other with respect to their ability to distinguish between different levels of coupling for various simulated experimental situations. We complement our numerical studies by investigating consistency and temporal variations of the strength of interactions within and between brain regions using intracranial electroencephalographic recordings from an epilepsy patient. Our findings indicate that the unweighted and weighted phase lag index are less prone to the influence of common sources but that this advantage may lead to constrictions limiting the applicability of these methods.

We investigate assortativity of functional brain networks before, during, and after one-hundred epileptic seizures with different anatomical onset locations. We construct binary functional networks from multi-channel electroencephalographic data recorded from 60 epilepsy patients; and from time-resolved estimates of the assortativity coefficient, we conclude that positive degree-degree correlations are inherent to seizure dynamics. While seizures evolve, an increasing assortativity indicates a segregation of the underlying functional network into groups of brain regions that are only sparsely interconnected, if at all. Interestingly, assortativity decreases already prior to seizure end. Together with previous observations of characteristic temporal evolutions of global statistical properties and synchronizability of epileptic brain networks, our findings may help to gain deeper insights into the complicated dynamics underlying generation, propagation, and termination of seizures.

We investigate the influence of various pathophysiologic and physiologic processes on global statistical properties of epileptic brain networks. We construct binary functional networks from long-term, multichannel electroencephalographic data recorded from 13 epilepsy patients, and the average shortest path length and the clustering coefficient serve as global statistical network characteristics. For time-resolved estimates of these characteristics we observe large fluctuations over time, however, with some periodic temporal structure. These fluctuations can--to a large extent--be attributed to daily rhythms while relevant aspects of the epileptic process contribute only marginally. Particularly, we could not observe clear cut changes in network states that can be regarded as predictive of an impending seizure. Our findings are of particular relevance for studies aiming at an improved understanding of the epileptic process with graph-theoretical approaches., (© 2010 American Institute of Physics.)

Debates on six controversial topics were held during the Fourth International Workshop on Seizure Prediction (IWSP4) convened in Kansas City, KS, USA, July 4-7, 2009. The topics were (1) Ictogenesis: Focus versus Network? (2) Spikes and Seizures: Step-relatives or Siblings? (3) Ictogenesis: A Result of Hyposynchrony? (4) Can Focal Seizures Be Caused by Excessive Inhibition? (5) Do High-Frequency Oscillations Provide Relevant Independent Information? (6) Phase Synchronization: Is It Worthwhile as Measured? This article, written by the IWSP4 organizing committee and the debaters, summarizes the arguments presented during the debates., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Objective: To investigate whether functional brain networks of epilepsy patients treated with antiepileptic medication differ from networks of healthy controls even during the seizure-free interval., Methods: We applied different rules to construct binary and weighted networks from EEG and MEG data recorded under a resting-state eyes-open and eyes-closed condition from 21 epilepsy patients and 23 healthy controls. The average shortest path length and the clustering coefficient served as global statistical network characteristics., Results: Independent on the behavioral condition, epileptic brains exhibited a more regular functional network structure. Similarly, the eyes-closed condition was characterized by a more regular functional network structure in both groups. The amount of network reorganization due to behavioral state changes was similar in both groups. Consistent findings could be achieved for networks derived from EEG but hardly from MEG recordings, and network construction rules had a rather strong impact on our findings., Conclusions: Despite the locality of the investigated processes epileptic brain networks differ in their global characteristics from non-epileptic brain networks. Further methodological developments are necessary to improve the characterization of disturbed and normal functional networks., Significance: An increased regularity and a diminished modulation capability appear characteristic of epileptic brain networks., (Copyright (c) 2009 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.)

Inferring directional interactions from biosignals is of crucial importance to improve understanding of dynamical interdependences underlying various physiological and pathophysiological conditions. We here present symbolic transfer entropy as a robust measure to infer the direction of interactions between multidimensional dynamical systems. We demonstrate its performance in quantifying driver-responder relationships in a network of coupled nonlinear oscillators and in the human epileptic brain.

Epilepsy is a malfunction of the brain that affects over 50 million people worldwide. Epileptic seizures are usually characterized by an abnormal synchronized firing of neurons involved in the epileptic process. In human epilepsy the exact mechanisms underlying seizure generation are still uncertain as are mechanisms underlying seizure spreading and termination. There is now growing evidence that an improved understanding of the epileptic process can be achieved through the analysis of properties of epileptic brain networks and through the analysis of interactions in such networks. In this overview, we summarize recent methodological developments to assess synchronization phenomena in human epileptic brain networks and present findings obtained from analyses of brain electromagnetic signals recorded in epilepsy patients.

We assess electrical brain dynamics before, during, and after 100 human epileptic seizures with different anatomical onset locations by statistical and spectral properties of functionally defined networks. We observe a concave-like temporal evolution of characteristic path length and cluster coefficient indicative of a movement from a more random toward a more regular and then back toward a more random functional topology. Surprisingly, synchronizability was significantly decreased during the seizure state but increased already prior to seizure end. Our findings underline the high relevance of studying complex systems from the viewpoint of complex networks, which may help to gain deeper insights into the complicated dynamics underlying epileptic seizures., ((c) 2008 American Institute of Physics.)

We study directional relationships-in the driver-responder sense-in networks of coupled nonlinear oscillators using a phase modeling approach. Specifically, we focus on the identification of drivers in clusters with varying levels of synchrony, mimicking dynamical interactions between the seizure generating region (epileptic focus) and other brain structures. We demonstrate numerically that such an identification is not always possible in a reliable manner. Using the same analysis techniques as in model systems, we study multichannel electroencephalographic recordings from two patients suffering from focal epilepsy. Our findings demonstrate that--depending on the degree of intracluster synchrony--certain subsystems can spuriously appear to be driving others, which should be taken into account when analyzing field data with unknown underlying dynamics.

The sudden and apparently unpredictable nature of seizures is one of the most disabling aspects of the disease epilepsy. A method capable of predicting the occurrence of seizures from the electroencephalogram (EEG) of epilepsy patients would open new therapeutic possibilities. Since the 1970s investigations on the predictability of seizures have advanced from preliminary descriptions of seizure precursors to controlled studies applying prediction algorithms to continuous multi-day EEG recordings. While most of the studies published in the 1990s and around the turn of the millennium yielded rather promising results, more recent evaluations could not reproduce these optimistic findings, thus raising a debate about the validity and reliability of previous investigations. In this review, we will critically discuss the literature on seizure prediction and address some of the problems and pitfalls involved in the designing and testing of seizure-prediction algorithms. We will give an account of the current state of this research field, point towards possible future developments and propose methodological guidelines for future studies on seizure prediction.

We investigate two recently proposed multivariate time series analysis techniques that aim at detecting phase synchronization clusters in spatially extended, nonstationary systems with regard to field applications. The starting point of both techniques is a matrix whose entries are the mean phase coherence values measured between pairs of time series. The first method is a mean-field approach which allows one to define the strength of participation of a subsystem in a single synchronization cluster. The second method is based on an eigenvalue decomposition from which a participation index is derived that characterizes the degree of involvement of a subsystem within multiple synchronization clusters. Simulating multiple clusters within a lattice of coupled Lorenz oscillators we explore the limitations and pitfalls of both methods and demonstrate (a) that the mean-field approach is relatively robust even in configurations where the single-cluster assumption is not entirely fulfilled and (b) that the eigenvalue-decomposition approach correctly identifies the simulated clusters even for low coupling strengths. Using the eigenvalue-decomposition approach we studied spatiotemporal synchronization clusters in long-lasting multichannel EEG recordings from epilepsy patients and obtained results that fully confirm findings from well established neurophysiological examination techniques. Multivariate time series analysis methods such as synchronization cluster analysis, which account for nonlinearities in the data, are expected to provide complementary information which allows one to gain deeper insights into the collective dynamics of spatially extended complex systems.

We propose a method for estimating phase synchronization between time series using the parallel computing architecture of cellular nonlinear networks (CNN's). Applying this method to time series of coupled nonlinear model systems and to electroencephalographic time series from epilepsy patients, we show that an accurate approximation of the mean phase coherence R--a bivariate measure for phase synchronization--can be achieved with CNN's using polynomial-type templates.

Objective: An important issue in epileptology is the question whether information extracted from the EEG of epilepsy patients can be used for the prediction of seizures. Several studies have claimed evidence for the existence of a pre-seizure state that can be detected using different characterizing measures. In this paper, we evaluate the predictability of seizures by comparing the predictive performance of a variety of univariate and bivariate measures comprising both linear and non-linear approaches., Methods: We compared 30 measures in terms of their ability to distinguish between the interictal period and the pre-seizure period. After completely analyzing continuous inctracranial multi-channel recordings from five patients lasting over days, we used ROC curves to distinguish between the amplitude distributions of interictal and preictal time profiles calculated for the respective measures. We compared different evaluation schemes including channelwise and seizurewise analysis plus constant and adaptive reference levels. Particular emphasis was placed on statistical validity and significance., Results: Univariate measures showed statistically significant performance only in a channelwise, seizurewise analysis using an adaptive baseline. Preictal changes for these measures occurred 5-30 min before seizures. Bivariate measures exhibited high performance values reaching statistical significance for a channelwise analysis using a constant baseline. Preictal changes were found at least 240 min before seizures. Linear measures were found to perform similar or better than non-linear measures., Conclusions: Results provide statistically significant evidence for the existence of a preictal state. Based on our findings, the most promising approach for prospective seizure anticipation could be a combination of bivariate and univariate measures., Significance: Many measures reported capable of seizure prediction in earlier studies are found to be insignificant in performance, which underlines the need for statistical validation in this field.

In a growing number of publications it is claimed that epileptic seizures can be predicted by analyzing the electroencephalogram (EEG) with different characterizing measures. However, many of these studies suffer from a severe lack of statistical validation. Only rarely are results passed to a statistical test and verified against some null hypothesis H0 in order to quantify their significance. In this paper we propose a method to statistically validate the performance of measures used to predict epileptic seizures. From measure profiles rendered by applying a moving-window technique to the electroencephalogram we first generate an ensemble of surrogates by a constrained randomization using simulated annealing. Subsequently the seizure prediction algorithm is applied to the original measure profile and to the surrogates. If detectable changes before seizure onset exist, highest performance values should be obtained for the original measure profiles and the null hypothesis. "The measure is not suited for seizure prediction" can be rejected. We demonstrate our method by applying two measures of synchronization to a quasicontinuous EEG recording and by evaluating their predictive performance using a straightforward seizure prediction statistics. We would like to stress that the proposed method is rather universal and can be applied to many other prediction and detection problems.

The exact mechanisms leading to the occurrence of epileptic seizures in humans are still poorly understood. It is widely accepted, however, that the process of seizure generation is closely associated with an abnormal synchronization of neurons. In order to investigate this process, we here measure phase synchronization between different regions of the brain using intracranial EEG recordings. Based on our preliminary finding of a preictal drop in synchronization, we investigate whether this phenomenon can be used as a sensitive and specific criterion to characterize a preseizure state and to distinguish this state from the interictal interval. Applying an automated technique for detecting decreased synchronization to EEG recordings from a group of 18 patients with focal epilepsy comprising a total of 117 h, we observe a characteristic decrease in synchronization prior to 26 out of 32 analyzed seizures at a very high specificity as tested on interictal recordings. The duration of this preictal state is found to range from several minutes up to a few hours. Investigation of the spatial distribution of preictal desynchronization indicates that the process of seizure generation in focal epilepsy is not necessarily confined to the focus itself but may instead involve more distant, even contralateral areas of the brain. Finally, we demonstrate an intrahemispheric asymmetry in the spatial dynamics of preictal desynchronization that is found in the majority of seizures and appears to be an immanent part of the mechanisms underlying the initiation of seizures in humans.

A rapidly growing number of studies deals with the prediction of epileptic seizures. For this purpose, various techniques derived from linear and nonlinear time series analysis have been applied to the electroencephalogram of epilepsy patients. In none of these works, however, the performance of the seizure prediction statistics is tested against a null hypothesis, an otherwise ubiquitous concept in science. In consequence, the evaluation of the reported performance values is problematic. Here, we propose the technique of seizure time surrogates based on a Monte Carlo simulation to remedy this deficit.

Beginning in the 1970s engineers designed systems to predict epileptic seizures based upon quantitative changes in the electroencephalogram, which they hypothesized began well in advance of clinical seizure onset. These efforts flourished in the 1990s, as independent laboratories demonstrated evidence of a 'preseizure period' up to 20 min prior to clinical symptoms in patients implanted with intracranial electrodes during evaluation for epilepsy surgery. Years later, clinical and laboratory experiments leave little doubt that a preseizure period exists in temporal lobe and perhaps other forms of epilepsy. Its existence, however, raises fundamental questions about what constitutes a seizure, what brain regions are involved in seizure generation, and whether discrete interictal, preictal, ictal and post-ictal physiologies exist, or blend together in a continuous process. Pressing milestones, necessary for clinical utility, are: (1) demonstrating prospective seizure prediction from prolonged human data sets, (2) elucidating mechanisms underlying seizure precursors and (3) implementing these algorithms on implantable hardware platforms. The notion of a preseizure state is catalyzing new clinical and basic science research, which has the potential to dramatically increase our understanding of epilepsy, and to generate exciting new therapies for patients.

Epilepsy types differ by pathophysiology and prognosis. Transcutaneous auricular vagus nerve stimulation (taVNS) is a non-invasive treatment option in epilepsy. Nevertheless, its mode of action and impact on different types of epilepsy are still unknown. We investigated whether short-term taVNS differently affects local and global characteristics of EEG-derived functional brain networks in different types of epilepsy. Thirty subjects (nine with focal epilepsy, 11 with generalized epilepsy, and 10 without epilepsy or seizures) underwent a 3-h continuous EEG-recording (1 h pre-stimulation, 1 h taVNS stimulation, 1 h post-stimulation) from which we derived evolving functional brain networks. We assessed—in a time-resolved manner—important global (topological, robustness, and stability properties) and local (centralities of vertices and edges) network characteristics. Compared to the subjects with focal epilepsies and without epilepsy, those with generalized epilepsies clearly presented with different topological properties of their functional brain network already at rest. Furthermore, subjects with focal and generalized epilepsies reacted differently to the stimulation, expressed as different taVNS-induced immediate and enduring reorganization of global network characteristics. On the local network scale, no discernible spatial pattern could be detected, which points to a rather unspecific and generalized modification of brain activity. Assessing functional brain network characteristics can provide additional information for differentiating between focal and generalized epilepsy. TaVNS-related modifications of global network characteristics clearly differ between epilepsy types. Impact of such a non–pharmaceutical intervention on clinical decision-making in the treatment of different epilepsy types needs to be assessed in future studies. [ABSTRACT FROM AUTHOR]

Transcutaneous auricular vagus nerve stimulation (taVNS) is a novel non-invasive treatment option for different diseases and symptoms, such as epilepsy or depression. Its mechanism of action, however, is still not fully understood. We investigated short-term taVNS-induced changes of local and global properties of EEG-derived, evolving functional brain networks from eighteen subjects who underwent two 1 h stimulation phases (morning and afternoon) during continuous EEG-recording. In the majority of subjects, taVNS induced measurable modifications of network properties. Network alterations induced by stimulation in the afternoon were clearly more pronounced than those induced by stimulation in the morning. Alterations mostly affected the networks' topology and stability properties. On the local network scale, no clear-cut spatial stimulation-related patterns could be discerned. Our findings indicate that the possible impact of diurnal influences on taVNS-induced network modifications would need to be considered for future research and clinical studies of this non-pharmaceutical intervention approach. [ABSTRACT FROM AUTHOR]

There is evidence that biofeedback of electrodermal activity (EDA) can reduce seizure frequency in people with epilepsy. Prior studies have linked EDA biofeedback to a diffuse brain activation as a potential functional mechanism. Here, we investigated whether short-term EDA biofeedback alters EEG-derived large-scale functional brain networks in people with epilepsy. In this prospective controlled trial, thirty participants were quasi-randomly assigned to one of three biofeedback conditions (arousal, sham, or relaxation) and performed a single, 30-min biofeedback training while undergoing continuous EEG recordings. Based on the EEG, we derived evolving functional brain networks and examined their topological, robustness, and stability properties over time. Potential effects on attentional-executive functions and mood were monitored via a neuropsychological assessment and subjective self-ratings. Participants assigned to the relaxation group seemed to be most successful in meeting the task requirements for this specific control condition (i.e., decreasing EDA). Participants in the sham group were more successful in increasing EDA than participants in the arousal group. However, only the arousal biofeedback training was associated with a prolonged robustness-enhancing effect on networks. Effects on other network properties were mostly unspecific for the different groups. None of the biofeedback conditions affected attentional-executive functions or subjective behavioral measures. Our results suggest that global characteristics of evolving functional brain networks are modified by EDA biofeedback. Some alterations persisted after the single training session; however, the effects were largely unspecific across the different biofeedback protocols. Further research should address changes of local network characteristics and whether multiple training sessions will result in more specific network modifications. [ABSTRACT FROM AUTHOR]

Transcutaneous auricular vagus nerve stimulation (taVNS) is a novel non-invasive brain stimulation technique considered as a potential supplementary treatment option for a wide range of diseases. Although first promising findings were obtained so far, the exact mode of action of taVNS is not fully understood yet. We recently developed an examination schedule to probe for immediate taVNS-induced modifications of large-scale epileptic brain networks. With this schedule, we observed short-term taVNS to have a topology-modifying, robustness- and stability-enhancing immediate effect on large-scale functional brain networks from subjects with focal epilepsies. We here expand on this study and investigate the impact of short-term taVNS on various local and global characteristics of large-scale evolving functional brain networks from a group of 30 subjects with and without central nervous system diseases. Our findings point to differential, at first glance counterintuitive, taVNS-mediated alterations of local and global topological network characteristics that result in a reconfiguration of networks and a modification of their stability and robustness properties. We propose a model of a stimulation-related stretching and compression of evolving functional brain networks that may help to better understand the mode of action of taVNS. [ABSTRACT FROM AUTHOR]

There is an ongoing debate whether generic early warning signals for critical transitions exist that can be applied across diverse systems. The human epileptic brain is often considered as a prototypical system, given the devastating and, at times, even life-threatening nature of the extreme event epileptic seizure. More than three decades of international effort has successfully identified predictors of imminent seizures. However, the suitability of typically applied early warning indicators for critical slowing down, namely, variance and lag-1 autocorrelation, for indexing seizure susceptibility is still controversially discussed. Here, we investigated long-term, multichannel recordings of brain dynamics from 28 subjects with epilepsy. Using a surrogate-based evaluation procedure of sensitivity and specificity of time-resolved estimates of early warning indicators, we found no evidence for critical slowing down prior to 105 epileptic seizures. [ABSTRACT FROM AUTHOR]

The human brain is a complex network of interacting nonstationary subsystems, whose complicated spatial-temporal dynamics is still poorly understood. Deeper insights can be gained from recent improvements of time-series-analysis techniques to assess strength and direction of interactions together with methodologies for deriving and characterizing evolving networks from empirical time series. Wehere review these developments, and by taking the example of evolving epileptic brain networks, we discuss the progress that has beenmade in capturing and understanding brain dynamics that varies on time scales ranging from seconds to years. [ABSTRACT FROM AUTHOR]

Abstract: Graph-theoretical analyses of complex brain networks is a rapidly evolving field with a strong impact for neuroscientific and related clinical research. Due to a number of confounding variables, however, a reliable and meaningful characterization of particularly functional brain networks is a major challenge. Addressing this problem, we present an analysis approach for weighted networks that makes use of surrogate networks with preserved edge weights or vertex strengths. We first investigate whether characteristics of weighted networks are influenced by trivial properties of the edge weights or vertex strengths (e.g., their standard deviations). If so, these influences are then effectively segregated with an appropriate surrogate normalization of the respective network characteristic. We demonstrate this approach by re-examining, in a time-resolved manner, weighted functional brain networks of epilepsy patients and control subjects derived from simultaneous EEG/MEG recordings during different behavioral states. We show that this surrogate-assisted analysis approach reveals complementary information about these networks, can aid with their interpretation, and thus can prevent deriving inappropriate conclusions. [Copyright &y& Elsevier]

Abstract: To improve the estimation of drift and diffusion coefficients of stochastic processes in case of a limited amount of usable data due to e.g. non-stationarity of natural systems we suggest to use kernel-based instead of histogram-based regression. We propose a method for bandwidth selection and compare it to a widely used cross-validation method. Kernel-based regression reveals an enhanced ability to estimate drift and diffusion especially for a small amount of data. This allows one to improve resolvability of changes in complex dynamical systems as evidenced by an exemplary analysis of electroencephalographic data recorded from a human epileptic brain. [Copyright &y& Elsevier]

We apply the method of frequency-selective excitation waves in excitable media to characterize synchronization phenomena in interacting complex dynamical systems by measuring coincidence rates of induced excitations. We relax the frequency-selectivity of excitable media and demonstrate two applications of the method to signals with broadband spectra. Findings obtained from analyzing time series of coupled chaotic oscillators as well as electroencephalographic (EEG) recordings from an epilepsy patient indicate that this method can provide an alternative and complementary way to estimate the degree of phase synchronization in noisy signals. [ABSTRACT FROM AUTHOR]

The framework of the theory of nonlinear dynamics provides powerful concepts and algorithms to study complicated dynamics such as brain electrical activity (electroencephalogram, EEG). Although different influencing factors render the use of nonlinear measures in a strict sense problematic, converging evidence from various investigations now indicates that nonlinear EEG analysis provides a means to reliably characterize different states of physiological and pathophysiological brain function. We here focus on applications of nonlinear EEG analysis in epileptology. Epilepsy affects more than 50 million individuals worldwide – approximately 1% of the world's population. The disease is characterized by a recurrent and sudden malfunction of the brain that is termed seizure. Nonlinear EEG analysis techniques allow to reliably identify the seizure generating structure (epileptic focus) in different areas of the brain even during seizure-free intervals, to disentangle complex spatio-temporal interactions between the epileptic focus and other areas of the brain, and to define a specific state predictive of an impending seizure. Nonlinear EEG analysis provides supplementary information about the epileptogenic process in humans, contributes to an improvement of the presurgical evaluation of epilepsy patients, and offers a basis for the development of new therapy concepts for seizure prevention. [ABSTRACT FROM AUTHOR]

We investigate the applicability of the permutation entropy H and a synchronization index γ that is based on the changing tendency of temporal permutation entropies to analyze noisy time series from nonstationary dynamical systems with poorly understood properties. Using model systems, we first study the interdependencies of parameters involved in the calculation of both measures. Having identified appropriate parameter settings we then analyze long-lasting EEG time series recorded from an epilepsy patient. Our findings indicate that γ could be of interest for studies on the predictability of epileptic seizures. [ABSTRACT FROM AUTHOR]

We investigate the relative merit of different linear and nonlinear synchronization measures for a characterization of the spatio-temporal dynamics of the epileptic process. Analyzing long-lasting multichannel electroencephalographic recordings from more than 20 epilepsy patients we show that all measures are able to identify brain regions of pathological synchronization associated with epilepsy, even during the seizure-free interval, and are able to detect a long-lasting transitional preseizure state. These findings render synchronization measures attractive for future prospective studies on seizure prediction. [ABSTRACT FROM AUTHOR]

Measuring the directionality of coupling between dynamical systems is one of the challenging problems in nonlinear time series analysis. We investigate the relative merit of two approaches to assess directionality, one based on phase dynamics modeling and one based on state space topography. We analyze unidirectionally coupled model systems to investigate the ability of the two approaches to detect driver-responder relationships and discuss certain problems and pitfalls. In addition we apply both approaches to the intracranial electroencephalogram (EEG) recorded from one epilepsy patient during the seizure-free interval to demonstrate the general suitability of directionality measures to reflect the pathological interaction of the epileptic focus with other brain areas. [ABSTRACT FROM AUTHOR]

Summary: The First International Collaborative Workshop on Seizure Prediction was held at the Department of Epileptology, University of Bonn, in Bonn, Germany on April 24–28, 2002. Organized by the Universities of Pennsylvania and Bonn, and funded by grants from the American Epilepsy Society, the German Section of the International League against Epilepsy, and the German Section of the International Federation of Clinical Neurophysiology, the workshop was attended by 51 researchers from 16 centers in seven countries. There were four major goals for the workshop: (1) to host a one-day didactic session on the science of seizure prediction, with lectures by leaders in the field; (2) to assess the current state of the field by applying current methods used to predict seizures to a shared set of continuous intracranial EEG data and discussing the strengths and weaknesses of each approach; (3) to establish a consensus on minimal data requirements, a common nomenclature, and objective methods for comparing system performance across platforms and laboratories for seizure prediction research; and most importantly (4) to establish a multi-laboratory, international working group dedicated to understanding seizure generation and making on-line, prospective seizure prediction a reality. Following the didactic course, each participating group presented their results, after applying their seizure prediction methods to five common data sets agreed upon in advance and distributed before the meeting. What follows is a description of the shared data set used for analysis, a summary of the major discussion points from the workshop, and points of consensus among the group. The brief discussion serves as a common introduction to the research papers that follow in this issue, and the description of the shared data is referenced in each of these papers. Participants in the workshop are listed at the end of the Conclusions section, in alphabetical order. [Copyright &y& Elsevier]

A number of recent studies indicate that nonlinear electroencephalogram (EEG) analyses allow to define a state predictive of an impending epileptic seizure. In this paper, we combine a method for detecting nonlinear determinism with a novel test for stationarity to characterize EEG recordings from both the seizure-free interval and the preseizure phase. We discuss differences between these periods, particularly an increased occurrence of stationary, nonlinear segments prior to seizures. These differences seem most prominent for recording sites within the seizure-generating area and for EEG segments less than one minute's length. [ABSTRACT FROM AUTHOR]

Stochastic approaches to complex dynamical systems have recently provided broader insights into spatial-temporal aspects of epileptic brain dynamics. Stochastic qualifiers based on higher-order Kramers-Moyal coefficients derived directly from time series data indicate improved differentiability between physiological and pathophysiological brain dynamics. It remains unclear, however, to what extent stochastic qualifiers of brain dynamics are affected by other endogenous and/or exogenous influencing factors. Addressing this issue, we investigate multi-day, multi-channel electroencephalographic recordings from a subject with epilepsy. We apply a recently proposed criterion to differentiate between Langevin-type and jump-diffusion processes and observe the type of process most qualified to describe brain dynamics to change with time. Stochastic qualifiers of brain dynamics are strongly affected by endogenous and exogenous rhythms acting on various time scales—ranging from hours to days. Such influences would need to be taken into account when constructing evolution equations for the epileptic brain or other complex dynamical systems subject to external forcings. [ABSTRACT FROM AUTHOR]

Inferring strength and direction of interactions from electroencephalographic (EEG) recordings is of crucial importance to improve our understanding of dynamical interdependencies underlying various physiological and pathophysiological conditions in the human epileptic brain. We here use approaches from symbolic analysis to investigate--in a time-resolved manner--weighted and directed, short- to long-ranged interactions between various brain regions constituting the epileptic network. Our observations point to complex spatial-temporal interdependencies underlying the epileptic process and their role in the generation of epileptic seizures, despite the massive reduction of the complex information content of multi-day, multi-channel EEG recordings through symbolization. We discuss limitations and potential future improvements of this approach. [ABSTRACT FROM AUTHOR]

Summary: Purpose: To assess whether EEG synchronization changes during short-term low-frequency electrical stimulation of the seizure onset zone. Methods: In 10 patients (34±11 years) with pharmaco-resistant epilepsy the seizure onset zone (9 temporal lobe, 1 frontal lobe) was electrically stimulated at 1Hz for 5min via intracranial electrodes. Bipolar stimuli were applied and four pulse widths (0.05, 0.1, 0.5, and 1.0ms) were tested. Stimulation amplitudes were held fixed at 1mA for strip electrodes and at 2mA for depth electrodes. Changes of EEG synchronization were assessed by the eigenvalue dynamics of the cross-correlation matrix computed from a 2.5s sliding window. Results: 37 stimulations were performed. We observed EEG desynchronization in 49% (18/37), an increase of EEG synchronization in 27% (10/37) and an EEG pattern with no significant change of synchronization in 24% (9/37). EEG synchronization most frequently occurred when stimulating with a pulse width of 0.5ms. In a patient with bilateral independent seizure onsets stimulation effects on EEG synchronization were different for each side. In the patient with the shortest duration of temporal lobe epilepsy, stimulation triggered periodic epileptic spikes phase-locked to stimulation. One patient experienced an aura during stimulation, which did not evolve into a seizure, and in one patient a sub-clincial seizure occurred. Discussion: Low-frequency stimulation of the seizure onset zone is associated with different changes of EEG synchronization and its effects depend on the widths of the stimulation pulses. It may be an appropriate stimulation technique for long-term studies assessing whether synchronized or desynchronized brain dynamics prevent seizure occurrence. [Copyright &y& Elsevier]

Abstract: Objective: To test whether increasing synchronization of neuronal activity might be causally related to seizure termination. Methods: Neuronal synchronization was assessed by the relative changes of the eigenvalue spectrum of the equal-time correlation matrix computed from a short window sliding along multi-channel EEGs, recorded with either intracranial or surface electrodes. Results: Synchronization dynamics of six status epilepticus EEG recordings from six patients were assessed. In all six recordings EEG synchronization fluctuated around relatively low levels during ongoing epileptiform activity. Synchronization only persistently increased before, or in one case, at the end of status epilepticus. Ongoing seizure activity stopped without pharmacological intervention in one patient. In four of the five other cases, the persistent increase of synchronization followed administration of anticonvulsant drugs. Conclusions: Our findings support the hypothesis that increasing synchronization of neuronal activity may be considered as an emergent self-regulatory mechanism for seizure termination. Significance: The traditional concept is challenged that increasing neuronal synchronization during epileptic seizures is always pathological and should be suppressed. On the contrary, our findings imply that therapeutic interventions to increase synchronization during seizures might be beneficial. [Copyright &y& Elsevier]