title: Predictability of uncontrollable multifocal seizures - towards new treatment options.
abstract: Drug-resistant, multifocal, non-resectable epilepsies are among the most difficult epileptic disorders to manage. An approach to control previously uncontrollable seizures in epilepsy patients would consist of identifying seizure precursors in critical brain areas combined with delivering a counteracting influence to prevent seizure generation. Predictability of seizures with acceptable levels of sensitivity and specificity, even in an ambulatory setting, has been repeatedly shown, however, in patients with a single seizure focus only. We did a study to assess feasibility of state-of-the-art, electroencephalogram-based seizure-prediction techniques in patients with uncontrollable multifocal seizures. We obtained significant predictive information about upcoming seizures in more than two thirds of patients. Unexpectedly, the emergence of seizure precursors was confined to non-affected brain areas. Our findings clearly indicate that epileptic networks, spanning lobes and hemispheres, underlie generation of seizures. Our proof-of-concept study is an important milestone towards new therapeutic strategies based on seizure-prediction techniques for clinical practice.
authors.affiliation: Department of Epileptology, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.|Helmholtz-Institute for Radiation and Nuclear Physics, University of Bonn, Nussallee 14-16, 53115 Bonn, Germany.|Interdisciplinary Center for Complex Systems, University of Bonn, Brühler Straβe 7, 53175 Bonn, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Lehnertz
authors.affiliation: Department of Epileptology, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.|Helmholtz-Institute for Radiation and Nuclear Physics, University of Bonn, Nussallee 14-16, 53115 Bonn, Germany.|Interdisciplinary Center for Complex Systems, University of Bonn, Brühler Straβe 7, 53175 Bonn, Germany.
authors.forename: Henning
authors.initials: H
authors.lastname: Dickten
authors.affiliation: Department of Epileptology, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.|Helmholtz-Institute for Radiation and Nuclear Physics, University of Bonn, Nussallee 14-16, 53115 Bonn, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Porz
authors.affiliation: Department of Epileptology, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Helmstaedter
authors.affiliation: Department of Epileptology, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.
authors.forename: Christian E
authors.initials: CE
authors.lastname: Elger
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000503:physiopathology; D000069279:Drug Resistant Epilepsy / Q000175:diagnosis* / Q000503:physiopathology; D004569:Electroencephalography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012640:Seizures / Q000175:diagnosis* / Q000503:physiopathology; D012680:Sensitivity and Specificity