How important is the seizure onset zone for seizure dynamics?

• We investigate the importance of various brain regions for seizure dynamics in epileptic networks.
• The seizure onset zone is rated as important in only about one third of cases.
• Neighborhood of seizure onset zone as target for individualized therapeutic interventions.
• Research into epileptic networks allows deeper insights into the epileptic process.

PurposeResearch into epileptic networks has recently allowed deeper insights into the epileptic process. Here we investigated the importance of individual network nodes for seizure dynamics.MethodsWe analysed intracranial electroencephalographic recordings of 86 focal seizures with different anatomical onset locations. With time-resolved correlation analyses, we derived a sequence of weighted epileptic networks spanning the pre-ictal, ictal, and post-ictal period, and each recording site represents a network node. We assessed node importance with commonly used centrality indices that take into account different network properties.ResultsA high variability of temporal evolution of node importance was observed, both intra- and interindividually. Nevertheless, nodes near and far off the seizure onset zone (SOZ) were rated as most important for seizure dynamics more often (65% of cases) than nodes from within the SOZ (35% of cases).ConclusionOur findings underline the high relevance of brain outside of the SOZ but within the large-scale epileptic network for seizure dynamics. Knowledge about these network constituents may elucidate targets for individualised therapeutic interventions that aim at preventing seizure generation and spread.