title: Human seizures self-terminate across spatial scales via a critical transition.
abstract: Why seizures spontaneously terminate remains an unanswered fundamental question of epileptology. Here we present evidence that seizures self-terminate via a discontinuous critical transition or bifurcation. We show that human brain electrical activity at various spatial scales exhibits common dynamical signatures of an impending critical transition--slowing, increased correlation, and flickering--in the approach to seizure termination. In contrast, prolonged seizures (status epilepticus) repeatedly approach, but do not cross, the critical transition. To support these results, we implement a computational model that demonstrates that alternative stable attractors, representing the ictal and postictal states, emulate the observed dynamics. These results suggest that self-terminating seizures end through a common dynamical mechanism. This description constrains the specific biophysical mechanisms underlying seizure termination, suggests a dynamical understanding of status epilepticus, and demonstrates an accessible system for studying critical transitions in nature.
authors.affiliation: Department of Mathematics and Statistics, Boston University, Boston, MA 02215, USA. mak@bu.edu
authors.forename: Mark A
authors.initials: MA
authors.lastname: Kramer
authors.forename: Wilson
authors.initials: W
authors.lastname: Truccolo
authors.forename: Uri T
authors.initials: UT
authors.lastname: Eden
authors.forename: Kyle Q
authors.initials: KQ
authors.lastname: Lepage
authors.forename: Leigh R
authors.initials: LR
authors.lastname: Hochberg
authors.forename: Emad N
authors.initials: EN
authors.lastname: Eskandar
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Madsen
authors.forename: Jong W
authors.initials: JW
authors.lastname: Lee
authors.forename: Atul
authors.initials: A
authors.lastname: Maheshwari
authors.forename: Eric
authors.initials: E
authors.lastname: Halgren
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Chu
authors.forename: Sydney S
authors.initials: SS
authors.lastname: Cash
mesh_terms: D000328:Adult; D001703:Biophysics / Q000379:methods; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping / Q000379:methods; D003198:Computer Simulation; D004562:Electrocardiography / Q000379:methods; D004566:Electrodes; D004569:Electroencephalography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D012640:Seizures / Q000503:physiopathology*; D013226:Status Epilepticus / Q000503:physiopathology*