The spatiotemporal dynamics of human focal seizures
Creators: Liou, Jyun-you
Publisher: name: Columbia University
Year: 2017
Subjects: subject: Neurosciences
subject: FOS: Clinical medicine
subject: Physiology
subject: FOS: Biological sciences
subject: Medicine

description: Spontaneous human focal seizures can present with a plethora of behavioral manifestations that vary according to the affected cortical regions; however, several key features have been consistently observed.  During my doctoral studies, I applied both theoretical and experimental methods to study mechanisms underpinning these consistently seen dynamics.  I first analyzed human intracranial EEG recordings, describing statistical methods for measuring their electrophysiological signatures.  I next proposed several neurophysiological hypotheses that could explain seizure dynamics and verified them in rodent seizure models.  Finally, a computational model was developed, successfully explaining how the complex spatiotemporal evolution of focal seizures emerges from simple neurophysiological principles.
      In Chapter 1, the long-standing behavioral manifestations and the most up-to-date electrophysiology findings are reviewed. This section details the inspiration for the studies reported in the subsequent chapters. 
      In Chapter 2, I describe several statistical methods for estimating traveling wave velocities.  I show most ictal discharges can be described as traveling waves whose velocities contain rich information about the stages of seizure evolution.  I compare performance of various statistical methods and propose a robust approach to boost the quality of each method’s estimation results.  
      In Chapter 3, I show how inhibition modulates seizure propagation patterns.  Surround inhibition spatially restrains focal seizures and masks excitatory projections of ictal activities.  When compromised, two patterns of seizure propagation emerge according to the position of inhibition defects relative to the ictal focus.  I show that two distant ictal foci can communicate via physiological connectivity without any chronic rewiring processes – confirming the existence of long-range propagation pathways that could lead to epileptic network formation.      
      In Chapter 4, I show that thalamic inputs might be necessary for interictal epileptiform discharges (IEDs).  The relative positions between IEDs and ictal foci indicate that surround inhibition, shown in the previous chapter, can be exhausted by repetitive exposure to ictal projections.
      In Chapter 5, I propose a neural network model that can explain both long-standing behavioral observations of seizures and account for the most up-to-date electrophysiological recordings of spontaneous human focal seizures.  The model relies on few assumptions, all of which are proved or supported in earlier chapters of this thesis.  The model explains phasic evolution of seizure dynamics – how the commonly observed patterns arise from simple neurophysiological principles, as well as seizure onset subtypes, traveling wave directions and speeds.  The model also predicts how spontaneous seizures might arise from synaptic plasticity.  The chapter ends with a discussion of the model’s implications and future work.
      The thesis is organized in a way that each chapter can be read independently, with Chapter 5 summarizing the central theory spanning the whole study.  Each chapter is also tightly linked to a clinically relevant question.  In sum, the dissertation’s goal is to provide an in-principle understanding of focal seizure dynamics.  With rapid advancement of clinical and experimental tools, I believe this work provides a roadmap for future therapies for epilepsy patients.