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of evidence Level III.The need to emphasize the network concept arises from the fact that the traditional surgical philosophy in American epilepsy centers has prioritized an electrical-anatomic, focus-oriented approach. In contrast, the stereoelectroencephalography philosophy focuses on using electrophysiology to determine the regions of cortex generating the clinical manifestation of the seizure. Viewing epilepsy surgery as network surgery enables optimal consideration of decisions related to the need for and method of intracranial monitoring, potential role of subcortical structures in seizure organization and propagation, upfront use of combinatorial therapies to prevent seizure emergence from the network, and use of neuromodulation in novel epilepsy indications.Neuromodulation, including first-generation open-loop devices and second-generation closed-loop devices, is a valuable but poorly understood therapeutic option for patients with drug-refractory epilepsy. A-674563 mouse The precise therapy a patient receives is contingent on the relationship between the patient's own unique neurophysiology and the custom programming of detection and stimulation parameters. Recent evidence demonstrates that therapeutic efficacy can be achieved through neuromodulation of seizure networks, rather than simple disruption of seizure evolution. Nevertheless, the improvement in outcomes achieved combined with its minimally invasive, nondestructive nature make closed-loop stimulation a promising therapy for additional indications, such as generalized and pediatric epilepsy.During the presurgical evaluation of patients with focal refractory epilepsies, the spatial mapping of the seizure onset zone (SOZ) and seizure propagation networks critically depends on the use of different features extracted from the intracranial electroencephalogram (IEEG). The identification of the SOZ is usually based on visual inspection by highly qualified neurophysiologists. However, quantitative IEEG analyses have recently been developed by exploiting signal and image characteristics in order to improve and expedite the SOZ detection. Here, the authors briefly review some of the latest methods proposed by different research groups and then present the recent implementation in Brainstorm software.Surgical procedures for the treatment of epilepsy and brain tumors can involve resection of regions closed or merged to functionally eloquent cortical areas. Removal of language, primary motor, or sensory areas can be associated with transient or permanent functional deficits, which should be avoided if possible. Functional electrical cortical stimulation is a reliable technique to prevent or minimize motor, sensory and language deficits and has been used in humans since the 1950s to identify functional cortex, and it can also localize epileptogenic regions. This article discusses functional electrical stimulation in adults and children for different functional modalities.The intracranial electroencephalogram (iEEG) is essential in decision making for epilepsy surgery. Although localization of epileptogenic brain regions by means of iEEG has been the gold standard for surgical decision-making for more than 70 years, established guidelines for what constitutes genuine iEEG epileptic activity and what is normal brain activity are not available. This review provides a summary of the current state of knowledge and understanding on normal iEEG entities and variants, the effects of sleep on regional and lobar iEEG, iEEG patterns of interictal and ictal epileptic activity and their relation to well-described epileptogenic pathologies and surgical outcome.The past decade has seen a significant shift in the number of centers performing intracranial electroencephalography from subdural grids and strips to stereoelectroencephalography (SEEG). Unlike grid and strip insertion or other stereotactic procedures in which the cortical surface is visualized, SEEG involves insertion of an electrode through a bolt anchored into the skull. Due to the multidisciplinary nature of SEEG trajectory planning, it often is time-consuming and iterative. Computer-assisted planning improves time taken and efficacy of SEEG trajectory planning. This article provides an overview of the considerations, controversies, and practicalities of implementing an automated computer-assisted planning solution for SEEG planning.Continuing advancements in neuroimaging methodology allow for increasingly detailed in vivo characterization of structural and functional brain networks, leading to the recognition of epilepsy as a disorder of large-scale networks. In surgical candidates, analysis of functional networks has proved invaluable for the identification of eloquent brain areas, such as hemispherical language dominance. More recently, connectome-based biomarkers have demonstrated potential to further inform clinical decision making in drug-refractory epilepsy. This article summarizes current evidence on epilepsy as a network disorder, emphasizing potential benefits of network analysis techniques for preoperative assessments and resection planning.Resective epilepsy surgery relies on accurate preoperative localization of the epileptogenic zone (EZ), so presurgical evaluation is necessary to obtain the most accurate information from clinical, anatomic, and neurophysiologic aspects, with the ultimate goal of performing an individualized surgical treatment. The noninvasive methods of seizure localization are complementary and results must be interpreted in conjunction, in an attempt to compose localization hypotheses of the anatomic location of the EZ. Stereoelectroencephalography is an extraoperative invasive method that is applied in patients with medically refractory focal epilepsy in order to anatomically define the EZ and the related functional cortical areas.Seizure semiology represents the dynamic clinical expression of seizures and is an important behavioral data source providing clues to cerebral organization. It is produced through interactions between electrical seizure discharge and physiologic and pathologic brain networks. Semiology is described in spatial and temporal terms; its expression depends on spatial (localization) and temporal (eg, discharge frequency, synchrony) characteristics of cerebral electrical activity. Stereoelectroencephalography studies of electroclinical correlations, including with quantified signal analysis, have helped elucidate several semiological patterns. Future research could help improve pattern recognition of complex semiological patterns, possibly using deep learning methods in a multiscale, multimodal modelization framework.Analysis of scalp electroencephalogram (EEG) findings is indispensable to investigation of epilepsy surgery candidates. Maxima of slowing and epileptiform spiking on interictal EEG reflect gross localization of core epileptogenic regions within a network. Important negative scalp EEG findings are those associated with deep foci. Ictal EEG is important in confirming concordance with interictal EEG and other ancillary data. Generalized interictal and ictal EEG findings may occur in epilepsies that are otherwise focal. Detailed individual analyses of scalp EEG features are prelude to a more global synthesis, whose coherence in suggesting plausible network hypothesis presage a subsequently successful scalp EEG evaluation.Epilepsy is characterized by specific alterations in network organization. The main parameters at the basis of epileptogenic network formation are alterations of cortical thickness, development of pathologic hubs, modification of hub distribution, and white matter alterations. The effect is a reinforcement of brain connectivity in both the epileptogenic zone and the propagation zone. Moreover, the epileptogenic network is characterized by some specific neurophysiologic biomarkers that evidence the tendency of the network itself to shift from an interictal state to an ictal one. The recognition of these features is crucial in planning epilepsy surgery.Posterior cortex epilepsies comprise all epilepsies with seizures generated from the occipital, parietal, and posterior temporal areas. Seizures usually occur early in life. Visual phenomena during seizures are the hallmark for occipital lobe seizures. Most patients show objective semiology mimicking seizures from other brain regions. Separation of symptomatogenic and epileptogenic zones complicates diagnosis. Understanding networks of propagation is crucial for planning surgery. An overview about typical clinical findings and prognostic value is presented. It explains ways to investigate the epileptogenic zone and propagation pathways to identify seizures from the posterior cortex and better categorize epilepsies for precise surgical treatment.Epilepsy affects about 1% of the general population. Frontal lobe epilepsy is the second most common focal epilepsy accounting for nearly 25% of medically refractory epilepsies. This paper reviews frontal lobe epilepsy from a perspective of a network disease that may help us to understand epilepsy from the microscale of genes, to local neuronal circuits, to the macrolevel of a whole-brain network. Surgical interventions, such as ablation and resection act by removing the active target nodes in the network, while responsive neurostimulation and vagus nerve stimulation act by modulating networks at the local neuronal circuit level and whole-brain level.Temporal lobe epilepsy (TLE) is the most common type of drug-resistant focal epilepsy. Epilepsy can be conceptualized as a network disorder with the epileptogenic zone a critical node of the network. Temporal lobe networks can be identified on the microscale and macroscale, both during the interictal and ictal periods. This review summarizes the current understanding of TLE networks as studied by neurophysiological and imaging techniques discussing both functional and structural connectivity.We provide a history and overview of the network approach to epilepsy surgery. Models of the epileptogenic zone (EZ) have evolved considerably over the years with more recent models accounting for the connectivity and network properties of epileptic foci. Next, we describe several examples of network phenotypes of focal epilepsy and how these have the potential to influence surgical decision-making and patient outcome. Future research will provide new insight into how network models of the EZ can determine optimal surgical interventions that improve seizure outcomes and optimize cognitive outcomes.Background Binge drinking is associated with poor academic behaviors and performance. Excessive alcohol drinking induces molecular changes and neurobehaviors that support use of other substances and alter cognitive functions. The purpose of this study was to compare neurobehaviors and academic effort among college students with low alcohol use with those of high alcohol consumption and build conceptual models that represent the integration of the different variables. Method College students from several U.S colleges were assessed through an anonymous online survey for alcohol use, academic performance, lifestyle factors and mental distress. Results Our results depicted common neurobehaviors and differential responses to high alcohol use. Conclusion The common responses in young men and women with high alcohol use are reflective of a hyperactive limbic system. The different responses involve cognitive aptitudes, typically controlled by cortical regions and affected by levels of brain connectivity known to be dissimilar between men and women.