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New method identifies brain regions most likely to cause epilepsy seizures

Mathematical approach could pinpoint which brain tissue should be removed during surgical treatment

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Scientists have developed a new way to detect which areas of the brain contribute most greatly to epilepsy seizures, according to a PLOS Computational Biology study. The strategy, devised by Marinho Lopes of the University of Exeter and colleagues, could help surgeons select specific brain areas for removal to stop seizures.

Epilepsy is a neurological disorder that affects about 1 out of every 100 people worldwide. Medications can often successfully control the seizures that characterize the disease, but about one third of patients require further treatment. Some receive surgery to remove brain regions that cause seizures, but only about 50 percent of surgeries result in long-term freedom from seizures.

To determine which areas of the brain may contribute most to a patient's seizures, surgeons typically examine electroencephalograms (EEGs), which reveal electrical activity in different parts of the brain. In the new study, an international team of scientists led by John Terry and other University of Exeter mathematicians sought to improve on this method.

The researchers first analyzed a database of EEG recordings taken from 16 patients who had already undergone surgery for epilepsy. They found that certain brain regions had more connections between each other and within themselves than did other regions. Such a well-connected network is known as a "rich club."

Using a mathematical modeling approach, the team then predicted that targeting rich clubs by removing especially well-connected nodes would reduce the number of seizures experienced by a patient. Real-world clinical data on the 16 patients confirmed: when surgery removed a greater proportion of the rich club, which is distinct in each patient, patients experienced fewer or no seizures in the long-term.

"What is truly exciting about our findings is the opportunity that such a method offers to identify the specific brain regions involved in the generation of seizures, which in turn can provide guidance on how to optimize surgical interventions to stop seizures," Lopes says.

Looking ahead, the research team plans to confirm these findings using data from more patients. They will also explore whether the method can be improved by integrating information from additional brain imaging techniques.

This press release is based on text provided by the authors.

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In your coverage please use this URL to provide access to the freely available article in PLOS Computational Biology: http://journals.plos.org/ploscompbiol/article?id=10.1371/journal.pcbi.1005637

Citation: Lopes MA, Richardson MP, Abela E, Rummel C, Schindler K, Goodfellow M, et al. (2017) An optimal strategy for epilepsy surgery: Disruption of the rich-club? PLoS Comput Biol 13 (8): e1005637. https://doi.org/10.1371/journal.pcbi.1005637

Funding: MAL, MG, MPR and JRT gratefully acknowledge funding from the Medical Research Council via grant MR/K013998/1. MG, MPR and JRT further acknowledge the financial support of the EPSRC via grant EP/N014391/1. The contribution of MG and JRT was further generously supported by a Wellcome Trust Institutional Strategic Support Award (WT105618MA). MPR and EA are supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust. KS gratefully acknowledges support by the Swiss National Science Foundation (SNF 32003B_155950). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests: The authors have declared that no competing interests exist.

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