AUTHOR=Langbein Jenna , Boddeti Ujwal , Kreinbrink Matthew , Khan Ziam , Rampalli Ihika , Bachani Muzna , Ksendzovsky Alexander TITLE=Therapeutic approaches targeting seizure networks JOURNAL=Frontiers in Network Physiology VOLUME=4 YEAR=2024 URL=https://www.frontiersin.org/journals/network-physiology/articles/10.3389/fnetp.2024.1441983 DOI=10.3389/fnetp.2024.1441983 ISSN=2674-0109 ABSTRACT=

Epilepsy is one of the most common neurological disorders, affecting over 65 million people worldwide. Despite medical management with anti-seizure medications (ASMs), many patients fail to achieve seizure freedom, with over one-third of patients having drug-resistant epilepsy (DRE). Even with surgical management through resective surgery and/or neuromodulatory interventions, over 50% of patients continue to experience refractory seizures within a year of surgery. Over the past 2 decades, studies have increasingly suggested that treatment failure is likely driven by untreated components of a pathological seizure network, a shift in the classical understanding of epilepsy as a focal disorder. However, this shift in thinking has yet to translate to improved treatments and seizure outcomes in patients. Here, we present a narrative review discussing the process of surgical epilepsy management. We explore current surgical interventions and hypothesized mechanisms behind treatment failure, highlighting evidence of pathologic seizure networks. Finally, we conclude by discussing how the network theory may inform surgical management, guiding the identification and targeting of more appropriate surgical regions. Ultimately, we believe that adapting current surgical practices and neuromodulatory interventions towards targeting seizure networks offers new therapeutic strategies that may improve seizure outcomes in patients suffering from DRE.