Consciousness alteration in focal epilepsy is related to loss of signal complexity and information processing.

Alteration of awareness is a main feature of focal epileptic seizures. In this work, we studied how the information contained in EEG signals was modified during temporal lobe seizures with altered awareness by using permutation entropy (PE) as a measure of the complexity of the signal. PE estimation was performed in thirty-six seizures of sixteen patients with temporal lobe epilepsy who underwent SEEG recordings. We tested whether altered awareness (based on the Consciousness Seizure Score) was correlated with a loss of signal complexity. We estimated global changes in PE as well as regional changes to gain insight into the mechanisms associated with awareness impairment. Our results reveal a positive correlation between the decrease of entropy and the consciousness score as well as the existence of a threshold on entropy that could discriminate seizures with no alteration of awareness from seizures with profound alteration of awareness. The loss of signal complexity was diffuse, extending bilaterally and to the associative cortices, in patients with profound alteration of awareness and limited to the temporal mesial structures in patients with no alteration of awareness. Thus PE is a promising tool to discriminate between the different subgroups of awareness alteration in TLE.

Stereo-EEG based personalized multichannel transcranial direct current stimulation in drug-resistant epilepsy.

OBJECTIVE: In epilepsy, multichannel transcranial direct electrical stimulation (tDCS) is applied to decrease cortical activity through the delivery of weak currents using several scalp electrodes. We investigated the long-term effects of personalized, multisession, stereotactic-EEG (SEEG)-targeted multichannel tDCS on seizure frequency (SF) and functional connectivity (Fc) as measured by EEG in patients with drug-resistant epilepsy (DRE). METHODS: Ten patients suffering from DRE were recruited. Multichannel tDCS (Starstim, Neuroelectrics) was applied during three cycles (one cycle every 2 months) of stimulation. Each cycle consisted of five consecutive days where patients received tDCS daily in two 20 min sessions separated by 20 min. The montages were personalized to target epileptogenic area of each patient as defined by SEEG recordings. SF during and after treatment was compared with baseline. Fc changes were analysed using scalp EEG recordings. RESULTS: After the last tDCS session, five patients experienced a SF decrease of 50% or more compared with baseline (R: responders, average SF decrease of 74%). We estimated Fc changes between cycles and across R and non-responder (NR) patients. R presented a significant decrease in Fc (p < 0.05) at the third session in alpha and beta frequency bands compared to the first one. CONCLUSIONS: Multichannel tDCS guided by SEEG is a promising therapeutic approach. Significant response was associated with a decrease of Fc after three stimulation cycles. SIGNIFICANCE: Such results suggest that tDCS-induced functional plasticity changes that may underlie the clinical response.

Interictal 18F-FDG brain PET metabolism in patients with postictal EEG suppression.

OBJECTIVE: Postictal generalized suppression (PGES) may be associated with SUDEP risk. We aimed to study metabolic changes on 18Fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) in patients with focal to bilateral (generalized) seizures (GTCS) and PGES on stereoelectroencephalography (SEEG). METHODS: We analyzed interictal brain metabolism in a group of 19 patients with widespread postictal suppression (PGES+) associated with SEEG-recorded GTCS. This group was compared to 25 patients without widespread suppression (PGES-) as defined by SEEG, matched for epilepsy localization and lateralization. Frequency of GTCS was observed to be higher in the PGES+ group (high risk group for SUDEP). Analysis of metabolic data was performed by statistical parametric mapping (SPM) on the whole-brain, and principal component analysis (PCA) on AAL (automated anatomical labeling) atlas. RESULTS: Statistical parametric mapping showed right temporal pole hypometabolism in the PGES+ group (T-score = 3.90; p < 0.001; k = 185), in comparison to the PGES- group. Principal component analysis showed association between the metabolic values of certain regions of interest and PGES+/PGES- groups, confirmed by a significant difference (p < 0.05) in the values of the right dorsal temporal pole and of the left temporal pole between the two groups. Principal component analysis showed two dimensions significantly related to the PGES+/PGES- partition, involving the following regions: right temporal pole, right parahippocampal gyrus, right Rolandic operculum, bilateral paracentral lobule, right precuneus, right thalamus, right caudate and pallidum, bilateral cerebellum, left temporal pole, left Heschl's gyrus, left calcarine region, and left caudate, with loss of connection in PGES+ patients. Metabolic differences were independent of epilepsy localization and lateralization and persisted after correction for GTCS frequency. SIGNIFICANCE: Interictal metabolic changes within a predominantly right-sided network involving temporal lobe and connected cortical and subcortical structures were seen in patients with frequent GTCS presenting widespread postictal suppression.