Epileptic seizures can be anticipated by non-linear analysis

Epileptic seizures are a principal brain dysfunction with important public health implications, as they affect 0.8% of humans. Many of these patients (20%) are resistant to treatment with drugs'. The ability to anticipate the onset of seizures in such cases would permit clinical interventions. The view of chronic focal epilepsy now is that abnormally discharging neurons act as pacemakers to recruit and entrain other normal neurons by loss of inhibition and synchronization into a critical mass(2). Thus, preictal changes should be detectable during the stages of recruitment. Traditional signal analyses, such as the count of focal spike density(3), the frequency coherence(4) or spectral analyses are not reliable predictors. Non-linear indicators may undergo consistent changes around seizure onset(5-7). Our objective was to follow the transition into seizure by reconstructing intracranial recordings in implanted patients as trajectories in a phase space and then introduce non-linear indicators to characterize them(8,9). These indicators take into account the extended spatio-temporal nature of the epileptic recruitment processes(10) and the corresponding physiological events governed by short-term causalities in the time series. We demonstrate that in most cases (17 of 19), seizure onset could be anticipated well in advance (between 2-6 minutes beforehand), and that all subjects seemed to share a similar 'route' towards seizure.