Recurring functional interactions predict network architecture of interictal and ictal states in neocortical epilepsy

Human epilepsy patients suffer from spontaneous seizures, which originate in brain regions that also subserve normal function. Prior studies demonstrate focal, neocortical epilepsy is associated with dysfunction, several hours before seizures. How does the epileptic network perpetuate dysfunction during baseline periods? To address this question, we developed an unsupervised machine learning technique to disentangle patterns of functional interactions between brain regions, or subgraphs, from dynamic functional networks constructed from approximately 100 hours of intracranial recordings in each of 22 neocortical epilepsy patients. Using this approach, we found: (i) subgraphs from ictal (seizure) and interictal (baseline) epochs are topologically similar, (ii) interictal subgraph topology and dynamics can predict brain regions that generate seizures, and (iii) subgraphs undergo slower and more coordinated fluctuations during ictal epochs compared to interictal epochs. Our observations suggest that the epileptic network drives dysfunction by controlling dynamics of functional interactions between brain regions that generate seizures and those that underlie normal function.