SUBDYNS

Context: A substantial portion of patients with drug-resistant epilepsy will not be eligible for resective surgery enhancing the need for neuromodulation techniques. The exact role of subcortical structures (basal ganglia and thalamus) in the propagation and termination of seizures remains debated. This research aims to comprehensively study the anatomical and functional connectivity of cortico-subcortical-cortical circuits during focal seizures, using neuroimaging, electrophysiological recordings, and neural mass modeling. Our hypothesis is that subcortical regions actively participate in seizure dynamics, and this understanding could help to develop new deep brain stimulation protocols for non-surgical focal epilepsies. Work Package 1: Combining imaging techniques (structural MRI, diffusion tensor imaging, and functional MRI) with stimulation-evoked local field potentials obtained from patients explored intracranially for drug-resistant epilepsy, we will be build an anatomical inward and outward connectivity map of cortico-subcortical circuits. Work Package 2: Non-linear regression analysis (h2) will be applied to understand changes in connectivity between cortical and subcortical regions during different phases of seizures in the same patients. This will allow the exploration of the temporal dynamic of cortico-subcortical functional connectivity during focal seizures. Work Package 3: Finally neural mass model of cortico-subcortical-cortical circuits will be developed based on “real-life” data obtained from the previous work packages. This model will help uncover the mechanisms underlying seizures, evaluate neuromodulation techniques' effectiveness, and identify potential targets for intervention in focal epilepsies. Conclusion: This research seeks to shed light on the role of subcortical networks in focal seizures and provide insights into potential therapeutic interventions for drug-resistant epilepsy.