Epilepsy as a dynamical system, a most needed paradigm shift in epileptology

The idea of the epileptic brain being highly excitable and facilitated to synchronic activity has guided pharmacological treatment since early twentieth century. Although tackling epilepsy's seizure-prone feature, by tonically modifying overall circuit excitability and/or connectivity, last 50 years drug development not seen a substantial improvement in seizure suppression refractory epilepsies. This review presents new conceptual framework for epilepsy which temporal dynamics disease plays more critical role both its understanding therapeutic strategies. repetitive epileptiform pattern (characteristic during ictal activity) other well-defined electrographic signatures (i.e., present interictal period) are discussed terms sequential activation motifs. Lessons learned from physiological neural circuitry used further corroborate argument explore transition proper function state instability. Furthermore, explores how interfering temporally dependent abnormal connectivity between circuits may work as approach. We also use probing stimulation access network evaluate power determine transitional states dynamical system it moves towards regions instability, especially when conventional monitoring is proven inefficient. Unorthodox cases, with little or no scalp correlate, ictogenic spread restricted neurovegetative, cognitive, motivational areas shown possible explanations sudden death (SUDEP) psychiatric comorbidities. In short, this paradigm shift way that we address aimed encourage debate rather than narrow rationale currently engaged in.This article part Special Issue “NEWroscience 2018".