Graph theoretical analysis of evoked potentials shows network influence of epileptogenic mesial temporal region

It is now widely accepted that seizures arise from the coordinated activity of epileptic networks, and as a result, traditional methods of analyzing seizures have been augmented by techniques like single‐pulse electrical stimulation (SPES) that estimate effective connectivity in brain networks. We used SPES and graph analytics in 18 patients undergoing intracranial EEG monitoring to investigate effective connectivity between recording sites within and outside mesial temporal structures. We compared evoked potential amplitude, network density, and centrality measures inside and outside the mesial temporal region (MTR) across three patient groups: focal epileptogenic MTR, multifocal epileptogenic MTR, and non‐epileptogenic MTR. Effective connectivity within the MTR had significantly greater magnitude (evoked potential amplitude) and network density, regardless of epileptogenicity. However, effective connectivity between MTR and surrounding non‐epileptogenic regions was of greater magnitude and density in patients with focal epileptogenic MTR compared to patients with multifocal epileptogenic MTR and those with non‐epileptogenic MTR. Moreover, electrodes within focal epileptogenic MTR had significantly greater outward network centrality compared to electrodes outside non‐epileptogenic regions and to multifocal and non‐epileptogenic MTR. Our results indicate that the MTR is a robustly connected subnetwork that can exert an overall elevated propagative influence over other brain regions when it is epileptogenic. Understanding the underlying effective connectivity and roles of epileptogenic regions within the larger network may provide insights that eventually lead to improved surgical outcomes.
Hays et al. utilize evoked potentials from single‐pulse electrical stimulation to map effective networks in mesial temporal epilepsy patients. Graph theoretical analysis of these connections is applied to characterize the role of mesial temporal structures within broader epileptogenic networks, revealing a highly hyperexcitable and influential densely connected subnetwork. This approach provides additional groundwork to better understand epilepsy as a network disorder and identify epileptogenic hubs of connectivity for network targeted treatments.