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Complex systems theory is a nebulous field whose overarching goal is to understand the dynamical behavior of systems consisting of many interconnected component parts. It has attracted widespread interest from many domains that study examples of such systems, including ecologists, sociologists, engineers, artificial intelligence researchers, condensed matter physicists, neuroscientists, and many others. The results of these collected, multi-disciplinary efforts have not been so much a comprehensive theory of Complex Systems (capital-C, capital-S), but rather a set of techniques, analogies, and attitudes toward problem solving that emphasize interactions and dynamics over individual components and their functions. The chapters are written in a complex adaptive systems frame and therefore it is useful to provide a provisional theoretical description of such systems. Following Holland , a generalizable description of complex adaptive systems is that they are collections of relatively simple agents that have the property that they can aggregate, so that collections of agents can form meta-agents (and meta-meta-agents etc.) with higher-order structure. These aggregates interact nonlinearly, so that the aggregate behavior of a collection of agents is qualitatively different from the behavior of the individual agents. The interactions among agents mediate flows of materials or information. Finally, the agents are typically diverse with distinct specialties that are optimized through adaptation to selective pressures in their environments.
The previous chapters have dealt with the complex adaptive nature of the genome. Similar concepts in terms of interacting elements, self-organization and adaptation can be applied at other hierarchical scales. In this chapter we will show how complex adaptive systems (CAS) concepts can be usefully applied at the level of action potential firing patterns of single neurons in terms of seizure generation and of associated morbidities.
The epilepsies are devastating neurological disorders for which progress developing effective new therapies has slowed over recent decades, primarily due to the complexity of the brain at all scales. This reality has shifted the focus of experimental and clinical practice toward complex systems approaches to overcoming current barriers. Organized by scale from genes to whole brain, the chapters of this book survey the theoretical underpinnings and use of network and dynamical systems approaches to interpreting and modeling experimental and clinical data in epilepsy. The emphasis throughout is on the value of the non-trivial, and often counterintuitive, properties of complex systems, and how to leverage these properties to elaborate mechanisms of epilepsy and develop new therapies. In this essential book, readers will learn key concepts of complex systems theory applied across multiple scales and how each of these scales connects to epilepsy.
Convulsive status epilepticus (CSE) is a common neurological emergency. Our objectives were to study children with recurrent nonfebrile CSE to assess the evidence for focal origin.
Series of 18 children with recurrent CSE and intractable epilepsy were identified by chart review. Clinical, radiological, and EEG data were reviewed. Focal structural abnormalities were identified on MRI and CT images by one neuroradiologist who was unaware of the clinical details.
The patient's ages ranged between 6-22 years (mean 15.3, SD 4), and 67% were males. Most children (89%) had a severe cognitive and / or behavioural disorder. Most patients (89%) had multiple seizure types and 95% of these were partial seizures. Twelve (67%) children had at least one episode of CSE with focal features identified clinically. Focal brain abnormalities were detected on 18% and 55% of CTand MRI films respectively. Overall, 53% had a focal abnormality on structural neuroimaging. Interictal EEG revealed focal or multifocal abnormalities on at least one occasion in 94% and 22% of patients respectively. Overall, 17 patients had focal features on at least one EEG. Thirteen ictal EEGs were recorded on 11 (61%) patients. Ten (91%) of these recordings revealed a focal onset.
Many handicapped children with recurrent CSE have focal clinical, radiological, or electrographic features. This supports a focal origin for CSE in most children with intractable epilepsy.
Convulsive status epilepticus (CSE) in children is important as it is associated with adverse outcomes including the development of subsequent epilepsy, learning impairments, and behavioral abnormalities. The most common etiology for CSE identified in children who were previously neurologically normal is a prolonged febrile seizure, that is, CSE associated with fever that is not associated with a central nervous system (CNS) infection in children aged between 6 months and 5 years. The high rate of CNS infection in children who have CSE associated with fever combined with the potential for missing the diagnosis leads to challenges in therapeutic decision making. The diagnosis, classification, and outcomes of non-convulsive status epilepticus (NCSE) in children continue to be a matter of debate, and therefore NCSE is defined broadly as a range of conditions in which electrographic seizure activity is prolonged and results in non-convulsive clinical symptoms.
Convulsive status epilepticus (CSE) is the most common medical neurological emergency and continues to be associated with significant morbidity and mortality. The two primary determinants of outcome from CSE are underlying aetiology and seizure length. It is unclear whether a prolonged seizure worsens the prognosis of an underlying aetiology or whether a more severe underlying disorder is more likely to result in CSE. Acceptance of the former hypothesis means that seizures need rapid treatment as their early termination could potentially reduce brain damage and morbidity. Pathophysiology, epidemiology, and outcomes from CSE have recently been reviewed elsewhere.
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