Identifying the epileptic network by linking interictal functional and structural connectivity

Over the last two decades, it has become increasingly clear that epilepsy is a network disorder. However, it is unclear whether these networks are established only during seizures or persist interictally. The goal of this study was to identify whether functional seizure networks exist interictally and evaluate if there is a structural basis to these networks. We identified four patients with mesial temporal lobe epilepsy who underwent resective epilepsy surgery. We estimated functional and structural connectivity across intracranial electrode contacts involved in seizure onset, early spread, and uninvolved controls. Across all interictal epochs considered, we found higher functional and white matter connectivity across cortical regions involved in seizure spread. Additionally, we observed that the patient in our cohort with the best seizure outcome had the highest functional connectivity across seizure contacts. Functional connectivity findings suggest the presence of an interictal seizure network that parallels underlying structural connectivity. Furthermore, our findings suggest that disruption or ablation of highly connected seizure regions may be necessary to achieve improved post-operative seizure freedom.