Advertisement

Epileptic Seizures May Begin Hours in Advance of Clinical Onset: A Report of Five Patients*

  • Brian Litt
  • Rosana Esteller
  • Javier Echauz
  • Maryann D'Alessandro
  • Rachel Shor
  • Thomas Henry
  • Page Pennell
  • Charles Epstein
  • Roy Bakay
  • Marc Dichter
  • George Vachtsevanos
Chapter
Part of the Intelligent Systems, Control, and Automation: Science and Engineering book series (ISCA, volume 39)

Research into mechanisms underlying seizure generation has traditionally focused on the seconds to at most few minutes before clinical seizure onset. In search of seizure predictors over longer periods of time, we analyzed continuous three to fourteen day EEG recordings from five consecutive patients with temporal lobe epilepsy implanted intracranially, with electrodes in and on the surface of the temporal lobes, during evaluation for epilepsy surgery. We found reliable, localized quantitative EEG changes, including increases in signal energy and brief bursts of rhythmic electrical discharges, indicating that epileptic seizures begin as a cascade of electrophysiological events that evolve over hours. Two important implications of these findings are: (1) neuroscientists investigating seizure generation must now focus on much longer time periods than were previously thought to be important to this process; and (2) an understanding of seizure precursors can be used to create implantable devices to forecast seizures and trigger intervention to prevent their electrical and clinical onset.

Keywords

Epileptic Seizure Temporal Lobe Epilepsy Seizure Onset Epilepsy Surgery Seizure Generation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    C.H. Bailey, D. Bartsch and E.R. Kandel, Toward a molecular definition of long-term memory storage, Proc. Natl. Acad. Sci. USA 93, 13445–13452, 1996.CrossRefGoogle Scholar
  2. 2.
    D.L. Burgess and J.L. Noebels, Single gene defects in mice: The role of voltage-dependent calcium channels in absence models, Epilepsy Res. 36, 111–122, 1999.CrossRefGoogle Scholar
  3. 3.
    M. Dichter and W.A. Spencer, Penicillin-induced interictal discharges from the cat hippocampus. I. Characteristics and topographical features, Journal of Neurophysiology 32, 649–662, 1969.Google Scholar
  4. 4.
    M. Dichter and W.A. Spencer, Penicillin-induced interictal discharges from the cat hippocampus. II. Mechanisms underlying origin and restriction, Journal of Neurophysiology 32, 663–687, 1969.Google Scholar
  5. 5.
    M.A. Dichter and G.F. Ayala, Cellular mechanisms of epilepsy: A status report, Science 237, 157–164, 1987CrossRefGoogle Scholar
  6. 6.
    M.A. Dichter, C.J. Herman, and M. Selzer, Silent cells during interictal discharges and seizures in hippocampal penicillin foci. Evidence for the role of extracellular K+ in the transition from the interictal state to seizures, Brain Res. 48, 173–183, 1972.CrossRefGoogle Scholar
  7. 7.
    J. Echauz, S. Kim, V. Ramani and G. Vachtsevanos, Neuro-fuzzy approaches to decision making: A comparative study with an application to check authorization, Journal of Intelligent and Fuzzy Systems 6, 259–278, 1998.Google Scholar
  8. 8.
    H.G. Eder, A. Stein and R.S. Fisher, Interictal and ictal activity in the rat cobalt/pilocarpine model of epilepsy decreased by local perfusion of diazepam, Epilepsy Res. 29, 17–24, 1997.CrossRefGoogle Scholar
  9. 9.
    J. Engel Jr., Outcome with respect to seizures, in Surgical Treatment of the Epilepsies, J. Engel Jr. (Ed.), Raven Press, New York, pp. 553–571, 1987.Google Scholar
  10. 10.
    W. Feindel, W. Penfield and H. Jasper, Localization of epileptic discharge in temporal lobe automatism, Trans. Am. Neurol. Assoc. 77, 14–17, 1952.Google Scholar
  11. 11.
    J. Glanz, Do chaos-control techniques offer hope for epilepsy? [news], Science 265, 1174, 1994.CrossRefGoogle Scholar
  12. 12.
    J. Gotman, Computer analysis of the EEG in epilepsy, in Methods of Analysis of Brain Electrical and Magnetic Signals: EEG Handbook, A. Gevins and A. Rémond (Eds.), Elsevier, Amsterdam, pp. 171–204, 1987.Google Scholar
  13. 13.
    J. Gotman, Relationships between interictal spiking and seizures: Human and experimental evidence, Canadian Journal of Neurologic Sciences 18, 573–576, 1991.Google Scholar
  14. 14.
    S.R. Haut, A.D. Legatt, C. O'Dell, S.L. Moshe and S. Shinnar, Seizure lateralization during EEG monitoring in patients with bilateral foci: The cluster effect, Epilepsia 38, 937–940, 1997.CrossRefGoogle Scholar
  15. 15.
    M.S. Heffernan, Comparative effects of microcurrent stimulation on EEG spectrum and correlation dimension, Integr. Physiol. Behav. Sci. 31, 202–209, 1996.CrossRefGoogle Scholar
  16. 16.
    L. Iasemidis, R. Gilmore, S. Roper and J. Sackellares, Dynamical interaction of the epilepto-genic focus with extrafocal sites in temporal lobe epilepsy (TLE) (abstract), Annals of Neurology 42, 429, 1997.Google Scholar
  17. 17.
    L. Iasemidis, L. Olson, R. Savit and J. Sackellares, Time dependencies in the occurrences of epileptic seizures: A nonlinear approach, Epilepsy Research 17, 81–94, 1994.CrossRefGoogle Scholar
  18. 18.
    L. Iasemidis, K. Pappas, R. Gilmore, S. Roper and J. Sackellares, Preictal entrainment of a critical cortical mass is a necessary condition for seizure occurrence, Epilepsia 37 (abstract), 1996.Google Scholar
  19. 19.
    L.D. Iasemidis, J.C. Sackellares, H.P. Zaveri and W.J. Williams, Phase space topography and the Lyapunov exponent of electrocorticograms in partial seizures, Brain Topogr. 2, 187–201, 1990.CrossRefGoogle Scholar
  20. 20.
    T. Kafri, H. van Praag, F.H. Gage and I.M. Verma, Lentiviral vectors: Regulated gene expression, Mol. Ther. 1, 516–521, 2000.CrossRefGoogle Scholar
  21. 21.
    A. Katz, D. Marks, G. McCarthy and S. Spencer, Does interictal spiking change prior to seizures? Electroencephalography and Clinical Neurophysiology 79, 153–156, 1991.CrossRefGoogle Scholar
  22. 22.
    H. Lange, J. Lieb, Jr, J. Engel and P. Crandall, Temporo-spatial patterns of pre-ictal spike activity in human temporal lobe epilepsy, Electroencephalography and Clinical Neurophysiology 56, 543–555, 1983.CrossRefGoogle Scholar
  23. 23.
    M. Le Van Quyen, C. Adam, J. Martinerie, M. Baulac, S. Clemenceau and F. Varela, Spatio-temporal characterizations of non-linear changes in intracranial activities prior to human temporal lobe seizures, Eur. J. Neurosci. 12, 2124–2134, 2000.CrossRefGoogle Scholar
  24. 24.
    K. Lehnertz and C. Elger, Can epileptic seizures be predicted? Evidence from nonlinear time series analysis of brain electrical activity, Physical Review Letters 80, 5019–5022, 1998.CrossRefGoogle Scholar
  25. 25.
    K. Lehnertz, G. Widman, R. Andrzejak, J. Arnhold and C.E. Elger, Is it possible to anticipate seizure onset by non-linear analysis of intracerebral EEG in human partial epilepsies?, Rev. Neurol. (Paris) 155, 454–456, 1999.Google Scholar
  26. 26.
    F. Liang and E.G. Jones, Zif268 and Fos-like immunoreactivity in tetanus toxin-induced epilepsy: Reciprocal changes in the epileptic focus and the surround, Brain Res. 778, 281–292, 1997.CrossRefGoogle Scholar
  27. 27.
    F.H. Lopes da Silva, J.P. Pijn and W.J. Wadman, Dynamics of local neuronal networks: Control parameters and state bifurcations in epileptogenesis, Prog. Brain Res. 102, 359–370, 1994.CrossRefGoogle Scholar
  28. 28.
    E.W. Lothman and J.M. Williamson, Closely spaced recurrent hippocampal seizures elicit two types of heightened epileptogenesis: A rapidly developing, transient kindling and a slowly developing, enduring kindling, Brain Res. 649, 71–84, 1994.CrossRefGoogle Scholar
  29. 29.
    J. Martinerie, C. Adam, M.L.V. Quyen, M. Baulac, S. Clemenceau, B. Renault and F. Varela, Epileptic seizures can be anticipated by non-linear analysis, Nature Medicine 4, 1173–1176, 1998.CrossRefGoogle Scholar
  30. 30.
    J.L. Noebels, Single-gene models of epilepsy, Adv. Neurol. 79, 227–238, 1999.Google Scholar
  31. 31.
    J.L. Noebels, X. Qiao, R.T. Bronson, C. Spencer and M.T. Davisson, Stargazer: A new neurological mutant on chromosome 15 in the mouse with prolonged cortical seizures, Epilepsy Res. 7, 129–135, 1990. (Published erratum in Epilepsy Res. 11(1), 72, March 1992.)CrossRefGoogle Scholar
  32. 32.
    J.L. Noebels and P.A. Rutecki, Altered hippocampal network excitability in the hypernorad-renergic mutant mouse tottering, Brain Res. 524, 225–230, 1990.CrossRefGoogle Scholar
  33. 33.
    I. Osorio, M. Frei and S. Wilkinson, Real-time automated detection and quantitative analysis of seizures and short-term prediction of clinical onset, Epilepsia 39, 615–627, 1998.CrossRefGoogle Scholar
  34. 34.
    W. Penfield and T.C. Erickson, Epilepsy and Cerebral Localization, Charles C. Thomas, Springfield, IL, 1941.Google Scholar
  35. 35.
    W. Penfield and H. Flanigin, Surgical therapy of temporal lobe seizures, Arch. Neurol. Psychi-atr. 64, 491–500, 1950.Google Scholar
  36. 36.
    D. Qin, A comparison of techniques for the prediction of epileptic seizures, in Proceedings of Eighth IEEE Symposium on Computer-Based Medical Systems, Lubbock, TX, pp. 151–157, 1995.Google Scholar
  37. 37.
    H. Qu and J. Gotman, A patient-specific algorithm for the detection of seizure onset in long-term EEG monitoring: Possible use as a warning device, IEEE Transactions of Biomedical Engineering 44, 115–122, 1997.CrossRefGoogle Scholar
  38. 38.
    P. Rajna, et al., Hungarian multicentre epidemiologic study of the warning and initial symptoms (prodrome, aura) of epileptic seizures, Seizure 6, 361–368, 1997.CrossRefGoogle Scholar
  39. 39.
    B. Ralston, The mechanism of transition of interictal spiking foci into ictal seizure discharge, Electroencephalography and Clinical Neurophysiology 10, 217–232, 1958.CrossRefGoogle Scholar
  40. 40.
    M. Risinger, J.J. Engel, P. VanNess, T. Henry and P. Crandall, Ictal localization of temporal seizures with scalp-sphenoidal recordings, Neurology 39, 1288–1293, 1989.Google Scholar
  41. 41.
    Z. Rogowski, I. Gath and E. Bental, On the prediction of epileptic seizures, Biological Cybernetics 42, 9–15, 1981.CrossRefGoogle Scholar
  42. 42.
    Y. Salant, I. Gath and O. Henriksen, Prediction of epileptic seizures from two-channel EEG, Medical & Biological Engineering & Computing 36, 549–556, 1998.CrossRefGoogle Scholar
  43. 43.
    R.M. Sanchez, C. Wang, G. Gardner, L. Orlando, D.L. Tauck, P.A. Rosenberg, E. Aizen-man and F.E. Jensen, Novel role for the NMDA receptor redox modulatory site in the patho-physiology of seizures, J. Neurosci. 20, 2409–2417, 2000.Google Scholar
  44. 44.
    Y. Schiller, G. Cascino, N. Busacker and F. Sharbrough, Characterization and comparison of local onset and remote propagated electrographic seizures recorded with intracranial electrodes, Epilepsia 39, 380–388, 1998.CrossRefGoogle Scholar
  45. 45.
    L.A. Schuh, T.R. Henry, D.A. Ross, B.J. Smith, K. Elisevich and I. Drury, Ictal spiking patterns recorded from temporal depth electrodes predict good outcome after anterior temporal lobectomy, Epilepsia 41, 316–319, 2000.CrossRefGoogle Scholar
  46. 46.
    P.A. Schwartzkroin, S.C. Baraban and D.W. Hochman, Osmolarity, ionic flux, and changes in brain excitability, Epilepsy Res. 32, 275–285, 1998.CrossRefGoogle Scholar
  47. 47.
    S. Spencer, P. Guimaraes, K. Katz, J. Kim and D. Spencer, Morphological patterns of seizures recorded intracranially, Epilepsia 33, 537–545, 1992.CrossRefGoogle Scholar
  48. 48.
    M. Sperling, Electrophysiology of the ictal-interictal transition in humans, in Mechanisms of Epileptogenesis: The Transition to Seizure, M.A. Dichter (Ed.), Plenum Press, New York, pp. 17–38, 1986.Google Scholar
  49. 49.
    M. Sperling and M. O'Connor, Auras and subclinical seizures: Characteristics and prognostic significance, Annals of Neurology 28, 320–328, 1990.CrossRefGoogle Scholar
  50. 50.
    A.G. Stein, H.G. Eder, D.E. Blum, A. Drachev and R.S. Fisher, An automated drug delivery system for focal epilepsy, Epilepsy Res. 39, 103–114, 2000.CrossRefGoogle Scholar
  51. 51.
    C.M. Tang, M. Dichter and M. Morad, Modulation of the N-methyl-D-aspartate channel by extracellular H+, Proc. Natl. Acad. Sci. USA 87, 6445–6449, 1990.CrossRefGoogle Scholar
  52. 52.
    S. Viglione, V. Ordon and F. Risch, A Methodology for Detecting Ongoing Changes in the EEG Prior to Clinical Seizures, McDonnel Douglas Astronautics Co., West Huntington Beach, CA, 1970.Google Scholar
  53. 53.
    L. Wang, T.C. Nichols, M.S. Read, D.A. Bellinger and I.M. Verma, Sustained expression of therapeutic level of factor IX in hemophilia B dogs by AAV-mediated gene therapy in liver, Mol. Ther. 1, 154–158, 2000.CrossRefGoogle Scholar
  54. 54.
    S. Ward and M. Rise, Techniques for treating epilepsy by brain stimulation and drug infusion, US Patent #5713923, 1998.Google Scholar

Copyright information

© Springer Science + Business Media B.V. 2009

Authors and Affiliations

  • Brian Litt
    • 1
  • Rosana Esteller
    • 2
    • 3
  • Javier Echauz
    • 4
  • Maryann D'Alessandro
    • 2
    • 5
  • Rachel Shor
    • 2
  • Thomas Henry
    • 6
  • Page Pennell
    • 6
  • Charles Epstein
    • 6
  • Roy Bakay
    • 6
  • Marc Dichter
    • 1
  • George Vachtsevanos
    • 2
  1. 1.Department of Neurology & BioengineeringHospital of the University of Pennsylvania PhiladelphiaUSA
  2. 2.School of Electrical & Computer EngineeringGeorgia Institute of TechnologyAtlantaUSA
  3. 3.Departamento Tecnología IndustrialUniversidad Simón BolívarCaracasVenezuela
  4. 4.Senior Research Scientist and PresidentJE Research, Inc.AlpharettaUSA
  5. 5.Army Research LabsAtlantaUSA
  6. 6.Department of NeurologyEmory University School of MedicineAtlantaUSA

Personalised recommendations

Cite chapter

Buy options