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Seizure pathways change on circadian and slower timescales in individual patients with focal epilepsy

Lookup NU author(s): Gabrielle Schroeder, Professor Andrew Trevelyan, Dr Rob ForsythORCiD, Professor Andrew Jackson, Dr Peter TaylorORCiD, Dr Yujiang WangORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Personalised medicine requires that treatments adapt to not only the patient, but changing factors within each individual. Although epilepsy is a dynamic disorder characterised by pathological fluctuations in brain state, surprisingly little is known about whether and how seizures vary in the same patient. We quantitatively compared within-patient seizure network evolutions using intracranial electroencephalographic (iEEG) recordings of over 500 seizures from 31 patients with focal epilepsy (mean 16.5 seizures/patient). In all patients, we found variability in seizure paths through the space of possible network dynamics.. Seizures with similar pathways tended to occur closer together in time, and a simple model suggested that seizure pathways change on circadian and/or slower timescales in the majority of patients. These temporal relationships occurred independent of whether the patient underwent antiepileptic medication reduction. Our results suggest that various modulatory processes, operating at different timescales, shape within-patient seizure evolutions, leading to variable seizure pathways that may require tailored treatment approaches.

Publication metadata

Author(s): Schroeder GM, Diehl B, Chowdhury FA, Duncan JS, de Tisi J, Trevelyan A, Forsyth R, Jackson A, Taylor PN, Wang Y

Publication type: Article

Publication status: Published

Journal: Proceedings of the National Academy of Sciences of the United States of America

Year: 2020

Volume: 117

Issue: 20

Pages: 11048-11058

Print publication date: 19/05/2020

Online publication date: 04/05/2020

Acceptance date: 25/03/2020

Date deposited: 21/04/2020

ISSN (print): 0027-8424

ISSN (electronic): 1091-6490

Publisher: National Academy of Sciences


DOI: 10.1073/pnas.1922084117


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Funder referenceFunder name
210109/Z/18/ZWellcome Trust
208940/Z/17/ZWellcome Trust