| The International Workshop on Seizure
Prediction (IWSP) is an ongoing series of international meetings on
seizure prediction, seizure dynamics and seizure control founded in
2002. IWSP has been bringing together researchers from a wide
range of backgrounds including epileptology, neurosurgery,
neurosciences, physics, mathematics, computer science, and
engineering. The workshops provide a regular, structured forum
for the exchange of ideas, dissemination of findings, and evaluation
of metrics to gauge progress. The workshops also form the
basis for development of future collaborative projects.
Background and Significance
Epilepsy, one of the most prevalent neurological disorders,
affects approximately 1% (>60 million) of the world’s population. In
an estimated 20 million of the patients, seizures are not controlled
even by multiple anti-seizure drugs. Uncontrolled seizures have
significant negative impacts for quality of life, and have been
shown to correlate with reduced life expectancy.
In the past 25 years, an interdisciplinary effort involving
epileptologists, engineers, physicists, mathematicians,
neurosurgeons and neuroscientists, the International Seizure
Prediction Group (ISPG), has attempted to approach the problem of
seizure prediction. Seizure prediction in its most basic form is the
identification of a preseizure state, and serves to remove one of
the most distressing aspects of epilepsy for patients: the
unpredictability of seizures. The ISPG has also addressed the
closely related topics of seizure localization and seizure
evolution.
At a more fundamental level, the goal of seizure prediction is to
identify the underlying mechanisms of seizure generation and to
engineer systems that will detect those dynamics and provide for
intervention, i.e. seizure control. As the field has matured, it has
become clear that before we can truly make progress, we need to
shift our focus to answer some crucial, basic, unresolved questions
that speak to these basic mechanisms (basic mechanism CBUQs). These
include:
- What constitutes a human focal-onset seizure at the level of
neural firing?
- How do seizures evolve spatially and terminate at all scales
from the cell to organism?
- What information is - and is not - reflected in the EEG, our
primary clinical diagnostic tool? What extensions to EEG –
scales of electrophysiological measures - should be used?
- What other dynamics and cycles such as sleep and stress
couple into the mechanisms of seizure generation?
- What other non-EEG measures of brain and behavior can be
utilized to reveal the underlying mechanisms of seizure
generation?
While these questions seem simple, it is rather astounding that
so little is known about them, even though 50 years have passed
since the neural signature of a seizure (the paroxysmal depolarizing
shift) was first described. In our view, this lack of insight into
seizure generation mechanisms and how it couples into the daily life
of patients is a major barrier to many potentially valuable
therapeutic epilepsy treatments. A major goal of the meeting is to
focus attention on new directions for investigation that have the
potential to bring real progress to the goals of seizure
localization and prediction, and that require the combined expertise
of clinical neurophysiology, bioengineering, and epilepsy
neuroscience.
Traditionally, epilepsy neurophysiology research has been divided
into two camps: a clinical approach that begins with EEG recordings
and attempts to divine information on the location and behavior of
neural activity, and a “bench” approach that uses a simplified model
of patterns thought to be important during clinical seizures, and
investigates interactions between sites or other physiological
structures. Very few investigators have been able to link these two
views. By bringing together investigators from both sides of the
divide and focusing attention on the interaction between EEG and
neural activity, we hope to facilitate new collaborations and
research directions that will advance the field in meaningful ways.
A similar divide exists between the modeling community and
experimentalists, clinicians, and engineers. What and how we measure
limit what we know about a system. Although EEG is the diagnostic
linchpin for surgical epilepsy treatment, there is an attitude in
the neuroscience community that discounts EEG as a mostly
meaningless and dirty metric of brain activity. Unfortunately,
because epilepsy is a human disease, the reality is that EEG is
currently the most accessible and widespread view into the dynamics
of human brain. The overall goal of the Seizure Prediction
Group is to develop treatments for epilepsy especially based on
closed loop prediction and interventions. While this goal
has not changed, the group has recognized that the focus of
attention needs to shift away from a biological mechanism-free
algorithmic approach to EEG and related electrophysiology
recordings, and toward a better understanding of underlying
physiological mechanisms as they specifically relate to clinical
recordings, and a better insight into how to OBSERVE these
mechanisms and their associated dynamics. It is the specific aim and
design of the proposed meeting to effect this shift. We will push to
close these divides and promote efforts that link theoretical and
computational modeling to observation of real systems.
This combined approach has not, to our knowledge, been the main
focus of any US or European conference held to date. The core ISPG
group is one that is uniquely suited to address these questions. As
a whole, the group has considerable expertise in clinical EEG
interpretation, signal processing, computer modeling, and
acquisition of high spatiotemporal resolution human and animal
datasets. In addition, it has historically attracted researchers
from the engineering community especially those able to and engaged
in development of devices for treatment of epilepsy.
The questions we now seek to address, however, require the
addition of epilepsy neuroscience expertise to the group’s skill
set. While there is some epilepsy neuroscience expertise within the
group, there is far more outside it. We therefore enlist scientists
from outside the traditional ISPG with established publication
records directly relevant to our topic areas as speakers and
participants. Additionally, we plan to recruit junior faculty,
residents pursuing careers as physician-scientists, and postdoctoral
and graduate students who are interested in delving into this
challenging area to attend and contribute posters.
International Workshop on Seizure Prediction (IWSP)
series
The ISPG group has held, to date, five international workshops
approximately every 18 months, alternating between the U.S. and
Europe. The workshops have addressed topics encompassing seizure
prediction, seizure generation, and seizure control.
Previous conferences in this series:
-
IWSP5 Dresden,
Germany in September 2011
organized by Ronald Tetzlaff, Christian Elger, and Klaus
Lehnertz
-
IWSP3 Freiburg, Germany in September 2007
organized by Andreas Schulze-Bonhage, Jens Timmer, and Björn
Schelter
(conference
book)
-
IWSP2 Bethesda, MD, USA in April 2006
organized by Leonidas Iasemidis, Chris Sackellares, Randall
Stewart, and Joseph Pancrazio
- IWSP1 Bonn, Germany in April 2002
organized by Klaus Lehnertz and Brian Litt
(summary
paper)
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