An updated systematic review and meta-analysis of brain network organization in focal epilepsy: Looking back and forth.

Abnormalities of the brain network organization in focal epilepsy have been extensively quantified. However, the extent and directionality of abnormalities are highly variable and subtype insensitive. We conducted meta-analyses to obtain a more accurate and epilepsy type-specific quantification of the interictal global brain network organization in focal epilepsy. By using random-effects models, we estimated differences in average clustering coefficient, average path length, and modularity between patients with focal epilepsy and controls, based on 45 studies with a total sample size of 1,468 patients and 1,021 controls. Structural networks had a significant lower level of integration in patients with epilepsy as compared to controls, with a standardized mean difference of -0.334 (95 % confidence interval -0.631 to -0.038; p-value 0.027). Functional networks did not differ between patients and controls, except for the beta band clustering coefficient. Our meta-analyses show that differences in the brain network organization are not as well defined as individual studies often propose. We discuss potential pitfalls and suggestions to enhance the yield and clinical value of network studies.