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A forward-looking review of seizure prediction

Freestone, Dean R.; Karoly, Philippa J.; Cook, Mark J.

doi: 10.1097/WCO.0000000000000429
SEIZURE DISORDERS: Edited by Matthew Walker

Purpose of review Seizure prediction has made important advances over the last decade, with the recent demonstration that prospective seizure prediction is possible, though there remain significant obstacles to broader application. In this review, we will describe insights gained from long-term trials, with the aim of identifying research goals for the next decade.

Recent findings Unexpected results from these studies, including strong and highly individual relationships between spikes and seizures, diurnal patterns of seizure activity, and the coexistence of different seizure populations within individual patients exhibiting distinctive dynamics, have caused us to re-evaluate many prior assumptions in seizure prediction studies and suggest alternative strategies that could be employed in the search for algorithms providing greater clinical utility. Advances in analytical approaches, particularly deep-learning techniques, harbour great promise and in combination with less-invasive systems with sufficiently power-efficient computational capacity will bring broader clinical application within reach.

Summary We conclude the review with an exercise in wishful thinking, which asks what the ideal seizure prediction dataset would look like and how these data should be manipulated to maximize benefits for patients. The motivation for structuring the review in this way is to create a forward-looking, optimistic critique of the existing methodologies.

aDepartment of Medicine, The University of Melbourne, St. Vincent's Hospital, Fitzroy

bDepartment of Electrical and Electronic Engineering, The University of Melbourne, Parkville, Victoria, Australia

cCenter for NeuroEngineering and Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, USA

Correspondence to Mark J. Cook, Department of Medicine, The University of Melbourne, St. Vincent's Hospital, Parkville, VIC 3010, Australia. E-mail:

Copyright © 2017 Wolters Kluwer Health, Inc. All rights resereved.