Epilepsia
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Up to 40% of patients with temporal lobe epilepsy (TLE) are refractory to medication. Surgery is an effective treatment but may cause new neurologic deficits including visual field deficits (VFDs). The ability to drive after surgery is a key goal, but a postoperative VFD precludes driving in 4-50% of patients even if seizure-free. ⋯ The optic radiation can be delineated in vivo using diffusion tensor imaging tractography, which has been shown to be useful in predicting the postoperative VFDs and in surgical planning. These data are now being used for surgical guidance with the aim of reducing the severity of VFDs. Compensation for brain shift occurring during surgery can be performed using intraoperative magnetic resonance imaging (MRI), but the additional utility of this expensive technique remains unproven.
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Brain functioning is increasingly seen as a complex interplay of dynamic neural systems that rely on the integrity of structural and functional networks. Recent studies that have investigated functional and structural networks in epilepsy have revealed specific disruptions in connectivity and network topology and, consequently, have led to a shift from "focus" to "networks" in modern epilepsy research. ⋯ In this review, we aim to provide an overview that would introduce the clinical neurologist and epileptologist to this new theoretical paradigm. We focus on the application of a theory, called "network analysis," to characterize resting-state functional and structural networks and discuss current and future clinical applications of network analysis in patients with epilepsy.