Pro-ictal, rather than pre-ictal, brain state marked by global critical slowing and local gamma power increase

This is the authors' abstract. We don't add key points for this paper.

Objective The pre-surgical evaluation of epilepsy relies on the electrophysiological recordings of spontaneous seizures. During this period drug dose decreases increase the likelihood of seizures transitioning the brain from a low to high seizure likelihood state, so-called pro-ictal state. This study aimed to identify the dynamic brain changes characteristic of this transition from 386 ten-minute segments of intracranial EEG recordings of 29 patients with drug-refractory temporal lobe epilepsy. Methods We studied brain dynamics through mean phase locking value and relative power in gamma band, and autocorrelation function width. We further explored interactions with pro-ictal factors, such as rate of interictal spikes and high frequency oscillations, circadian and multi-day cycles, and clinical outcomes. Results We observed significant increases in gamma power in the epileptogenic zone, and critical slowing in both the epileptogenic zone and presumably healthy cortex. These changes were linked with increases in spike and high frequency oscillations rate. Conclusions Brain dynamics changed on the slow time scale - from the beginning to the end of the multi-day interval - but did not change in the short-term during the pre-ictal interval, thus could reflect pro-ictal changes. Significance We highlight gamma power and critical slowing indices as markers of pro-ictal brain states, as well as their potential to track the seizure-related brain mechanisms during the presurgical evaluation of epilepsy patients. Highlights Study of multi-day brain dynamics during presurgical evaluation in drug-resistant temporal lobe epilepsy. Increasing seizure susceptibility is marked by a gamma power rise in the epileptogenic zone and network-wide critical slowing. Changes occur over days, not minutes before seizures, suggesting a multi-day pro-ictal phenomenon during presurgical evaluation.