Active probing to highlight approaching transitions to ictal states in coupled neural mass models

The extraction of electrophysiological features that reliably forecast the occurrence of seizures is one of the most challenging goals in epilepsy research. Among possible approaches to tackle this problem is the use of active probing paradigms in which responses to stimuli are used to detect underlying system changes leading up to seizures. This work evaluates the theoretical and mechanistic underpinnings of this strategy using two coupled populations of the well-studied Wendling neural mass model. Different model settings are evaluated, shifting parameters (excitability, slow inhibition, or inter-population coupling gains) from normal towards ictal states while probing stimuli are applied every 2 seconds to the input of either one or both populations. The correlation between the extracted features and the ictogenic parameter shifting indicates if the impending transition to the ictal state may be identified in advance. Results show that not only can the response to the probing stimuli forecast seizures but this is true regardless of the altered ictogenic parameter. That is, similar feature changes are highlighted by probing stimuli responses in advance of the seizure including: increased response variance and lag-1 autocorrelation, decreased skewness, and increased mutual information between the outputs of both model subsets. These changes were mostly restricted to the stimulated population, showing a local effect of this perturbational approach. The transition latencies from normal activity to sustained discharges of spikes were not affected, suggesting that stimuli had no pro-ictal effects. However, stimuli were found to elicit interictal-like spikes just before the transition to the ictal state. Furthermore, the observed feature changes highlighted by probing the neuronal populations may reflect the phenomenon of critical slowing down, where increased recovery times from perturbations may signal the loss of a systems' resilience and are common hallmarks of an impending critical transition. These results provide more evidence that active probing approaches highlight information about underlying system changes involved in ictogenesis and may be able to play a role in assisting seizure forecasting methods which can be incorporated into early-warning systems that ultimately enable closing the loop for targeted seizure-controlling interventions. Author summary Epilepsy is characterized by spontaneous and recurrent seizures. Developing a method to forecast the occurrence of these events would ease part of the burden to patients by providing warning systems and identifying critical periods for closed-loop seizure suppressing methods. However, this task is far from trivial and doing this in a clinical setting has been a challenge that is not yet solved. A possible way to achieve this is by using active probing paradigms, in which stimuli are used to highlight otherwise hidden changes in brain dynamics that may lead to seizures. In this work, this approach is tested in a computational model with two coupled neuronal populations. Active probing responses highlighted underlying model parameter changes that led neuronal activity closer to seizures, something that was not detected with the passive observation in most evaluated model settings. Observed feature changes revealed higher excitability, longer recovery times from stimuli, and increased synchrony between populations as the threshold to seizure-like activity approached. This indicates that low frequency stimuli may be used to reveal early-warning signs and assist in seizure forecasting methods.