Moraes, Márcio Flávio Dutra, de Castro Medeiros, Daniel, Mourao, Flávio Afonso Gonçalves, Cancado, Sergio Augusto Vieira and Cota, Vinícius Rosa (2021) Epilepsy as a dynamical system, a most needed paradigm shift in epileptology. Epilepsy & Behavior, 121 (106838). pp. 1-9. ISSN 1525-5050
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Abstract
The idea of the epileptic brain being highly excitable and facilitated to synchronic activity has guided pharmacological treatment since the early twentieth century. Although tackling epilepsy's seizure-prone feature, by tonically modifying overall circuit excitability and/or connectivity, the last 50 years of drug development has not seen a substantial improvement in seizure suppression of refractory epilepsies. This review presents a new conceptual framework for epilepsy in which the temporal dynamics of the disease plays a more critical role in both its understanding and therapeutic strategies. The repetitive epileptiform pattern (characteristic during ictal activity) and other well-defined electrographic signatures (i.e., present during the interictal period) are discussed in terms of the sequential activation of the circuit motifs. Lessons learned from the physiological activation of neural circuitry are used to further corroborate the argument and explore the transition from proper function to a state of instability. Furthermore, the review explores how interfering in the temporally dependent abnormal connectivity between circuits may work as a therapeutic approach. We also review the use of probing stimulation to access network connectivity and evaluate its power to determine transitional states of the dynamical system as it moves towards regions of instability, especially when conventional electrographic monitoring is proven inefficient. Unorthodox cases, with little or no scalp electrographic correlate, in which ictogenic circuitry and/or seizure spread is temporally restricted to neurovegetative, cognitive, and motivational areas are shown as possible explanations for sudden death in epilepsy (SUDEP) and other psychiatric comorbidities. In short, this review presents a paradigm shift in the way that we address the disease and is aimed to encourage debate rather than narrow the rationale epilepsy is currently engaged in. This article is part of the Special Issue “NEWroscience 2018". © 2019 Elsevier Inc.
| Item Type: | Article |
|---|---|
| Keywords: | Clinical approach; Electrographic signatures; Nonmotor areas; Probing stimulation; Temporal dynamics; Therapeutic strategy; |
| Academic Unit: | Faculty of Science and Engineering > Electronic Engineering Faculty of Science and Engineering > Research Institutes > Hamilton Institute |
| Item ID: | 21173 |
| Identification Number: | 10.1016/j.yebeh.2019.106838 |
| Depositing User: | Vinicius Cota |
| Date Deposited: | 09 Feb 2026 16:20 |
| Journal or Publication Title: | Epilepsy & Behavior |
| Publisher: | Elsevier |
| Refereed: | Yes |
| Related URLs: | |
| Use Licence: | This item is available under a Creative Commons Attribution Non Commercial Share Alike Licence (CC BY-NC-SA). Details of this licence are available here |
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