Common network related to hyperkinetic seizures revealed by functional lesion network mapping

Abstract Objective This study aims to determine whether the anatomically heterogeneous lesions that cause hyperkinetic seizures (HKS) are connected to a common functional network. Methods We identified patients from the Beijing Tiantan‐Fengtai Epilepsy Center with HKs as the primary ictal semiology. These included patients had focal seizure‐onset zone, here referred to as a “lesion.” The network of brain regions functionally connected to each lesion was identified using whole‐brain functional connectivity from a functional magnetic resonance imaging (fMRI) dataset of healthy participants ( n = 1000). Network maps were overlapped to identify regions functionally connected to most lesions. Specificity was evaluated using a case–control design. Therapeutic relevance was assessed using a cohort that underwent deep brain stimulation to the anterior nucleus of the thalamus to improve seizure control. Results Lesion locations for patients with HKS ( n = 50) and patients without HKS ( n = 47 for automatisms; n = 53 for elementary motor signs) were included. Based on the lesion brain network, the most sensitive and specific region with HKS was the anterior cingulate cortex (ACC) (>90% overlap). Reversed connectivity patterns between the ACC and the whole brain encompassed most lesion locations that caused HKS (47/50, 94%). In addition, the functional connectivity between ACC and deep brain stimulation sites was associated with improved seizure control ( r = .49, p < .01) in 27 patients with drug‐resistant epilepsy. Significance These findings indicated that HKS might be a symptom of brain network disruption that resulted from lesions in various brain regions commonly connected to ACC, emphasizing the ACC as a potential target for therapeutic intervention in HKS.