Abstract

There is a marked increase in the amount of electrophysiological and neuroimaging works dealing with the study of large scale brain connectivity in the epileptic brain. Our view of the epileptogenic process in the brain has largely evolved over the last twenty years from the historical concept of “epileptic focus” to a more complex description of “Epileptogenic networks” involved in the genesis and “propagation” of epileptic activities. In particular, a large number of studies have been dedicated to the analysis of intracerebral EEG signals to characterize the dynamic of interactions between brain areas during temporal lobe seizures. These studies have reported that large scale functional connectivity is dramatically altered during seizures, particularly during temporal lobe seizure genesis and development. Dramatic changes in neural synchrony provoked by epileptic rhythms are also responsible for the production of ictal symptoms or changes in patient’s behaviour such as automatisms, emotional changes or consciousness alteration. Beside these studies dedicated to seizures, large-scale network connectivity during the interictal state has also been investigated not only to define biomarkers of epileptogenicity but also to better understand the cognitive impairments observed between seizures.

Highlights

  • Review Approximately 30% of focal epilepsies are resistant to antiepileptic drugs

  • With regard to these reviews, our objectives were to focus on works studying functional connectivity from stereotactic EEG (SEEG) signals, to propose a general framework (“the epileptogenic network concept”) and to show how this concept may give clues in the comprehension of some clinical manifestations encountered in partial epilepsies

  • These data have been mainly obtained in the context of presurgical evaluation of temporal lobe epilepsy (TLE) and based on the analysis of intracerebral depth-EEG signals

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Summary

Introduction

Review Approximately 30% of focal epilepsies are resistant to antiepileptic drugs. In this situation, surgical resection of the epileptogenic zone (EZ) is the only therapeutic option able to suppress seizures. We concentrate on studies from our group dealing with the analysis of synchronization processes between distant structures recorded by intracerebral electrodes during seizure genesis and development. These data have been mainly obtained in the context of presurgical evaluation of temporal lobe epilepsy (TLE) and based on the analysis of intracerebral depth-EEG signals. Recent works suggest that even at rest during the interictal period these networks are associated with changes in functional connectivity We will illustrate these findings by discussing results we obtained using both intracerebral EEG recordings and resting-state functional MRI. The epileptogenic zone network The EZ may be considered as a general notion encompassing different conditions

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