Presurgical epileptogenic network analysis: A way to enhance epilepsy surgery outcome

Accurate localization of the "epileptogenic zone (EZ)" is an important issue in epilepsy surgery. The EZ is not discrete and focal; in fact, the epileptogenic networks can spread ictal activity to different regions of the brain. Changes in network characteristics and functional connectivity are shown to be associated with epilepsy. Seizures are thought to represent a hyper-synchronous state and presumable changes in synchronization between different brain regions underlie the mechanisms of seizure spread. Although presurgical evaluation of the epileptogenic network analysis can be carried out using existing investigative techniques like electroencephalogram (EEG), video-EEG, magnetic resonance imaging, single-photon emission computed tomography, and magnetoencephalography, advanced imaging techniques such as optical intrinsic spectroscopy, auto-fluorescence imaging, voltage sensitive dye imaging, and calcium imaging have the advantage of better spatiotemporal resolution over a large area of cortex. Understanding the wide-scale dynamic networks by analyzing the changes in the synchronization patterns using advanced imaging techniques will be instrumental in the presurgical analysis of the epileptogenic network and better localization of the EZs in the future.