Predicting epileptic seizures with a mental simulation task: a prospective study

The unpredictability of seizures is one of the most disabling aspects of epilepsy. We assessed the possibility of forecasting seizure onset by means of a behavioral task using mental simulation of biological and nonbiological movements. Four patients with epilepsy were included in a longitudinal study. In two patients with right temporal lobe epilepsy (RTLE), performance of the task changed depending on the epileptic cycle. In the preictal phase, timing precision decreased during simulation of biological movements and increased during simulation of nonbiological movements. In two other patients, the timing precision during simulation of biological movements was chronically decreased. The observed phase dependency of performance in patients with RTLE may indicate changes in brain states hours in advance of seizure onset. We suggest that our paradigm might be a simple and accurate method for the prediction of epileptic seizures. The validity of the approach for different types of epilepsy should be assessed in future studies.