Imaging preictal hemodynamic changes in neocortical epilepsy

Object. The ability to predict seizure occurrence is extremely important to trigger abortive therapies and to warn patients and their caregivers. Optical imaging of hemodynamic parameters such as blood flow, blood volume, and tissue and hemoglobin oxygenation has already been shown to successfully localize epileptic events with high spatial and temporal resolution. The ability to actually predict seizure occurrence using hemodynamic parameters is less well explored. Methods. In this article, the authors critically review data from the literature on neocortical epilepsy and optical imaging, and they discuss the preictal hemodynamic changes and their application in neurosurgery. Results. Recent optical mapping studies have demonstrated preictal hemodynamic changes in both human and animal neocortex. Conclusions. Optical measurements of blood flow and oxygenation may become increasingly important for predicting and localizing epileptic events. The ability to successfully predict ictal onsets may be useful to trigger closed-loop abortive therapies.