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Aperiodic activity is a physiologically distinct component of theelectrophysiological power spectrum. It is suggested to reflect the balance ofexcitation and inhibition in the brain, within selected frequency bands.However, the impact of recurrent seizures on aperiodic activity remainsunknown, particularly in patients with severe bilateral seizures. Here, wehypothesised greater aperiodic abnormality in the epileptogenic zone, inpatients with focal to bilateral tonic clonic (FBTC) seizures, and earlier ageof seizure onset.  Pre-operative magnetoencephalography (MEG) recordings were acquired from 36patients who achieved complete seizure freedom (Engel I outcome) post-surgicalresection. A normative whole brain map of the aperiodic exponent was computedby averaging across subjects for each region in the hemisphere contralateral tothe side of resection. Selected regions of interest were then tested forabnormality using deviations from the normative map in terms of z-scores.Resection masks drawn from postoperative structural imaging were used as anapproximation of the epileptogenic zone.  Patients with FBTC seizures had greater abnormality compared to patients withfocal onset seizures alone in the resection volume (p=0.003, area under the ROCcurve = 0.78 ). Earlier age of seizure onset was correlated with greaterabnormality of the aperiodic exponent in the resection volume (correlationcoefficient = -0.3, p= 0.04)) as well as the whole cortex (rho = -0.33,p=0.03). The abnormality of the aperiodic exponent did not significantly differbetween the resected and non-resected regions of the brain.  Abnormalities in aperiodic components relate to important clinicalcharacteristics such as severity and age of seizure onset. This suggests thepotential use of the aperiodic band power component as a marker for severity ofepilepsy.

Aperiodic MEG abnormality in patients with focal to bilateral tonic-clonic seizures