Abstract
Personalised medicine requires that treatments adapt to not only the patient, but changing factors within each individual. In focal epilepsy, brain dynamics change over time and modulate pathological processes; however, surprisingly little is known about whether and how seizures vary in the same patient. We quantitatively compared within-subject seizure network dynamics using intracranial recordings of ∼700 seizures from 31 patients with focal epilepsy (mean 16.5 seizures/subject) and three canines with focal-onset seizures (mean 62.3 seizures/subject). In all subjects, we found variability in seizure paths through the space of possible network dynamics, producing either a spectrum or clusters of different dynamics. Seizures with similar pathways tended to occur closer together in time, independent of whether antiepileptic medication reduction occurred, but did not necessarily have similar durations or circadian profiles. Our results suggest that slow modulatory processes shape within-subject seizure dynamics, leading to variable seizure pathways that may require tailored treatment approaches.
