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Gauging seizure risk.

Maxime O Baud1, Vikram R Rao2

  • 1From the Sleep-Wake-Epilepsy Center and Center for Experimental Neurology, Department of Neurology (M.O.B.), Inselspital, Bern University Hospital, University of Bern; Wyss Center for Bio- and Neuro-engineering (M.O.B.), Geneva, Switzerland; and Department of Neurology and Weill Institute for Neurosciences (V.R.R.), University of California, San Francisco. maxime.baud.neuro@gmail.com.

Neurology
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Summary
This summary is machine-generated.

Epilepsy is a cyclical disorder. Implanted devices reveal daily brain activity cycles, enabling personalized seizure risk forecasting and chronotherapy for better treatment outcomes.

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Area of Science:

  • Neurology
  • Biomedical Engineering
  • Epileptology

Background:

  • Epilepsy treatment typically involves antiepileptic drugs, followed by surgery for drug-resistant cases.
  • Neurostimulation devices offer therapeutic benefits and diagnostic capabilities for chronic brain activity monitoring.
  • Current treatment paradigms may not fully leverage the potential of long-term brain activity recordings.

Purpose of the Study:

  • To review evidence supporting epilepsy as a cyclical disorder.
  • To advocate for earlier integration of implanted monitoring devices in epilepsy management.
  • To explore the potential of chronic electroencephalography (EEG) for personalized seizure risk assessment and chronotherapy.

Main Methods:

  • Review of recent studies utilizing chronic EEG monitoring devices (over months to years).
  • Analysis of findings related to daily and multiday brain activity cycles influencing seizure timing.
  • Examination of the diagnostic capabilities of implanted neurostimulation devices.

Main Results:

  • Convergent findings from two studies reveal distinct daily and multiday brain activity cycles.
  • These cycles are associated with predictable seizure timing.
  • Patient-specific cycles can be identified and utilized for forecasting seizure risk.

Conclusions:

  • Epilepsy exhibits cyclical patterns that can be monitored using chronic EEG.
  • Integrating implanted monitoring devices earlier could enable risk-stratified treatment strategies and chronotherapy.
  • This approach may improve patient quality of life and reduce the need for resective surgery, requiring interdisciplinary collaboration.