Measurable transitions during seizures in intracranial EEG: A stereoelectroencephalography and SPECT study.

• Our multimodal quantitative method unveils directional dynamics of epileptic network during interictal to ictal transition. • Epileptogenic zone exhibits maximum outflow during preictal, and at seizure onset. • Regions that are hypoperfused during seizures exhibit maximum outflow during ictal evolution and can serve as a control network. Ictal Single Photon Emission Computed Tomography (SPECT) and stereo-electroencephalography (SEEG) are diagnostic techniques used for the management of patients with drug-resistant focal epilepsies. While hyperperfusion patterns in ictal SPECT studies reveal seizure onset and propagation pathways, the role of ictal hypoperfusion remains poorly understood. The goal of this study was to systematically characterize the spatio-temporal information flow dynamics between differently perfused brain regions using stereo-EEG recordings. We identified seizure-free patients after resective epilepsy surgery who had prior ictal SPECT and SEEG investigations. We estimated directional connectivity between the epileptogenic-zone (EZ), non-resected areas of hyperperfusion, hypoperfusion, and baseline perfusion during the interictal, preictal, ictal, and postictal periods. Compared to the background, we noted significant information flow (1) during the preictal period from the EZ to the baseline and hyperperfused regions, (2) during the ictal onset from the EZ to all three regions, and (3) during the period of seizure evolution from the area of hypoperfusion to all three regions. Hypoperfused brain regions were found to indirectly interact with the EZ during the ictal period. Our unique study, combining intracranial electrophysiology and perfusion imaging, presents compelling evidence of dynamic changes in directional connectivity between brain regions during the transition from interictal to ictal states. [ABSTRACT FROM AUTHOR]