Balancing Seizure Control with Cognitive Side Effects Using Changes in Theta

Abstract

Abstract This chapter discusses the growing evidence that seizure generation and cognitive deficits have a similar pathological source characterized by, but not limited to, deficits in theta oscillations and their influence on interneurons that is part of a larger pathological brain network. The authors discuss new tools and techniques that are being used to identify this larger pathological network, how it overlaps with cognitive networks, and how therapies need to be developed that consider both the seizure network and the overlap with cognitive networks. A new framework is presented that describes oscillatory states in epilepsy as alternating between hyper- and hyposynchrony rather than solely the spontaneous transition to hyperexcitability characterized by the seizures. This framework suggests a pathological imbalance between excitation and inhibition in favor of synchronous inhibition during interictal theta oscillations that could account for both the seemingly spontaneous nature of seizures and comorbid cognitive deficits. The chapter concludes that there is a need to understand epilepsy as impacting extensive brain networks in order to optimize outcome for patients.