Seizure Prediction 6: [LINE SEPARATOR]From Mechanisms to Engineered Interventions for Epilepsy.

Abstract

Epilepsy is a common neurological disorder that affects nearly 1% of the world’s population, and is characterized by the occurrence of recurrent spontaneous seizures. The apparent unpredictability of seizures is both a hallmark of the disorder and one of the primary factors contributing to the degradation in quality of life and increased potential for accidental injury (Arthurs et al. 2010). Unpredictability also increases the difficulty of achieving good seizure control. Patients with uncontrolled seizures have been shown to have increased risk of comorbid conditions that include sudden unexplained death in epilepsy (SUDEP), and increases the overall burden of the disorder on family members and caregivers. In November of 2013 we had the opportunity, along with Bjorn Schelter and Susan Arthurs, to organize the Sixth of the International Workshops on Seizure Prediction (IWSP). This is an interdisciplinary gathering of engineers, physicists, mathematicians, epileptologists, neurosurgeons and neuroscientists, self-termed the International Seizure Prediction Group (ISPG). The goals of the ISPG are to bring quantitative and technological approaches to addressing the prediction and control of epilepsy. There are two widely quoted targeted products from seizure prediction. First, successful seizure prediction enables development of devices and strategies for seizure intervention and improvement in quality of life. A simple advance warning of a high likelihood of a seizure can potentially enable a person with epilepsy to avoid situations that might place themselves or others at risk. Second, reliable and accurate seizure prediction would result in useful insights into the mechanistic underpinnings of seizure generation and related brain activity abnormalities. In particular, these may enable us to accomplish the “holy grail” of epilepsy treatment: focal seizure prevention to minimize the cognitive, behavioral and quality of life effects from both the treatments and the seizure events. We expect that articulating these and placing them into the context of human seizures and EEG recordings will increase the chances that the twin goals of seizure prediction and technology-based development of new prevention strategies will be realized. The IWSP series was initiated at the beginning of this century as a platform within which the ISPG can exchange ideas and identify high priority avenues for future investigation, with progress documented in summaries following each meeting. Thus, these meetings and their output serve a similar role as the formal Epilepsy Benchmarks (Kelley et al. 2009), to which many ISPG members have contributed. By way of introduction, we provide here a short history of seizure prediction from the last century leading up to the birth of the IWSP series, followed by a summary of the identified goals as emerging from the previous IWSPs. We then outline the significant achievements made in seizure prediction and the future goals of the ISPG as further detailed in the invited reviews. We close with an attached letter from Susan Arthurs, IWSP6 co-organizer and Chair of the Alliance for Epilepsy Research, which provides a patient’s perspective on the import of this research.