Precursors of seizures due to specific spatial-temporal modifications of evolving large-scale epileptic brain networks
Precursors of seizures due to specific spatial-temporal modifications of evolving large-scale epileptic brain networks
复制标题
DOI：
10.1038/s41598-019-47092-w
复制
发表时间：
2019-07-23
影响因子：
4.6
通讯作者：
Lehnertz, Klaus
中科院分区：
文献类型：
--
作者：
Rings, Thorsten;von Wrede, Randi;Lehnertz, Klaus
了解癫痫发作是何时、何地以及如何在大规模癫痫脑网络中开始的，仍然是一个广泛未解决的问题。癫痫前兆——预测即将发作的癫痫的大脑动力学变化——现在可以在临床表现之前识别出来，但是癫痫发作区或远端的大脑区域被报道为癫痫前兆出现的网络节点。我们的目的是阐明不断发展的癫痫网络的成分的作用，这些成分反复地进入和退出癫痫发作。我们从38例药物难治性癫痫患者3200多小时的连续颅内脑电图记录中构建了这样的网络。我们成功地挑出了预测边和预测节点。在97例癫痫发作中，有78例发作前的特征，即边缘权重和节点中心性（网络理论的一个基本概念），与发作间的特征有显著差异。绝大多数预测节点是由大多数预测边缘连接起来的，但这些节点在不断发展的癫痫网络中从未发挥过核心作用。有趣的是，预测节点完全与被认为不受局灶性癫痫过程影响的大脑区域相关。我们提出了一种过渡到癫痫前状态的网络机制，该机制透视了癫痫发作区在这种过渡中的作用，并强调了重新评估当前癫痫发作和预防概念的必要性。
Knowing when, where, and how seizures are initiated in large-scale epileptic brain networks remains a widely unsolved problem. Seizure precursors - changes in brain dynamics predictive of an impending seizure - can now be identified well ahead of clinical manifestations, but either the seizure onset zone or remote brain areas are reported as network nodes from which seizure precursors emerge. We aimed to shed more light on the role of constituents of evolving epileptic networks that recurrently transit into and out of seizures. We constructed such networks from more than 3200 hours of continuous intracranial electroencephalograms recorded in 38 patients with medication refractory epilepsy. We succeeded in singling out predictive edges and predictive nodes. Their particular characteristics, namely edge weight respectively node centrality (a fundamental concept of network theory), from the pre-ictal periods of 78 out of 97 seizures differed significantly from the characteristics seen during inter-ictal periods. The vast majority of predictive nodes were connected by most of the predictive edges, but these nodes never played a central role in the evolving epileptic networks. Interestingly, predictive nodes were entirely associated with brain regions deemed unaffected by the focal epileptic process. We propose a network mechanism for a transition into the pre-seizure state, which puts into perspective the role of the seizure onset zone in this transition and highlights the necessity to reassess current concepts for seizure generation and seizure prevention.