ICNC2022 Symposium: Epilepsy Networks: Seizures, Surgery and Neuronal Plasticity
Chair Lakshmi Nagarajan
Perth Children's Hospital
Speaker Georgia Ramantani
University Childrens Hospital, Zurich
Co-Chair Francesco Pisani
University of Parma, Italy
Speaker Soumya Ghosh
Perth Childrens Hospital
Neuronal networks underpin recurrent seizures in the children with well controlled and refractory epilepsies. Epilepsy duration is known to have a negative effect on cognition, behaviour and seizure outcomes. In this symposium we wish to highlight how understanding epilepsy networks through clinical trajectories, neurophysiology and modulation of brain activity, may lead to optimal early and effective therapy (medical/surgical) for children with epilepsy.
This symposium should provoke thinking about epilepsy networks among the many paediatricians/child neurologists who treat children with seizures. It should raise awareness of the importance of early evaluation and appropriate medical or surgical intervention in children with refractory epilepsy. It should enthuse more clinicians to train in paediatric epileptology.
This symposium will explain the concept and relevance of epilepsy networks. It will stimulate enthusiasm and the desire to be more proactive in the management of epilepsy in children. It will emphasize the importance of early referral of children with refractory epilepsy to specialist epilepsy programs, in-order to minimize the duration of epilepsy.
Talks in this symposium
Neonatal Seizures and Epileptogenesis - Prof Francesco Pisani
EEG, Surgery and Epilepsy Networks
EEG, Surgery and Epilepsy Networks
SEEG, Surgery and Epilepsy Network
This talk will focus on the heterogeneity of epilepsy networks revealed by SEEG in children with polymicrogyria and other cortical malformations. First, it will highlight the partial or lack of involvement of MRI-visible lesions such as polymicrogyria in the epileptogenic zone, in stark contrast to the more concise concordance between the lesion and the epileptogenic zone that is encountered in focal cortical dysplasia. Second, it will discuss the role of SEEG in children with epilepsy in cases where surgical strategy should not be predominantly MRI-, but rather SEEG-oriented. Third, it will offer an insight into the strategy of SEEG-based epileptogenic zone delineation and consequent resection in cases where we cannot generally rely on the rough concordance of electroclinical and neuroimaging findings. Finally, this talk will highlight the importance of timely referral and early intervention for affected children, particularly in early life, underlining benefits in seizure freedom and cognitive development. Crucial aspects of patient counseling, treatment management, and prognostication in pediatric lesional epilepsy will be in the spotlight of this presentation.
Epilepsy Networks and Non Invasive Brain Stimulation
This talk will address the role of non-invasive brain stimulation (NIBS) in understanding epilepsy networks. NIBS techniques are painless and relatively safe, and can be used to investigate brain function in awake, cooperative adults and children. Transcranial magnetic stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS) are common NIBS techniques that are being increasingly used in clinical and research settings to investigate and modulate cortical excitability in neurological disorders including epilepsy. Epilepsy is associated with hyperexcitable neurons and hypersynchrony of neural circuits. Thus, NIBS is well suited to investigate cortical excitability in epilepsy, to understand seizure mechanisms, and effects of treatment. Cortical excitability changes have been investigated in the motor cortex of patients with generalized and focal epilepsy (including focal epilepsy involving non-motor cortical areas). In comparison with adults, there are fewer TMS studies in children with epilepsy. The capacity of non-invasive brain stimulation to induce lasting changes in brain excitability has been applied for treatment trials in epilepsy. Preliminary studies of TMS and tDCS show promise, but more studies are needed to confirm the role and benefit of these techniques in the understanding, investigation and management of epilepsy and its comorbidities.