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    Functional connectivity is altered in epilepsy, with reinforced connections within epileptic zones and poorer outcomes linked to widespread connectivity changes. This highlights the role of brain networks in seizure dynamics and prognosis.

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    Area of Science:

    • Neuroscience
    • Epileptology
    • Network Science

    Background:

    • Drug-refractory focal epilepsies are network disorders with altered functional connectivity during both ictal and interictal periods.
    • Previous studies primarily used fMRI, with limited use of high-temporal-resolution electrophysiology like stereotactic-EEG (sEEG).
    • Most sEEG studies focused on temporal lobe epilepsy, neglecting other forms of refractory epilepsy.

    Purpose of the Study:

    • To investigate interictal functional connectivity alterations in drug-refractory focal epilepsies using sEEG.
    • To explore the association between functional connectivity patterns and postsurgical prognosis.
    • To analyze functional connectivity within and between the epileptogenic zone (EZ), propagation zone (PZ), and noninvolved zone (NIZ).

    Main Methods:

    • Studied a cohort of 59 patients with malformation of cortical development undergoing sEEG.
    • Recorded from 76 distinct brain areas per patient, calculating functional connectivity using nonlinear correlation.
    • Compared functional connectivity within and between EZ, PZ, and NIZ, and analyzed its association with postsurgical outcomes.

    Main Results:

    • Functional connectivity decreased gradually from EZ and PZ to NIZ.
    • Preferential coupling was observed within the EZ and between the EZ and PZ.
    • Higher functional connectivity in the NIZ (within-NIZ, between NIZ and PZ) was associated with poorer postsurgical outcomes.

    Conclusions:

    • Interictal functional connectivity is reinforced within epileptic cortices (EZ and PZ), showing gradual organization.
    • Widespread functional connectivity alterations correlate with poorer postsurgical prognosis, suggesting more diffuse disease.
    • These findings underscore the importance of brain connectivity in seizure dynamics and epilepsy management.