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Degeneracy in epilepsy: Multiple Routes to Hyperexcitable Brain Circuits and their Repair

Developing effective therapies against epilepsy remains a challenge. The complex and multifaceted nature of this disease still fuels controversies about its origin. In this perspective article, we argue that conflicting hypotheses can be reconciled by taking into account the degeneracy of the brain, which manifests in multiple routes leading to similar function or dysfunction. We exemplify degeneracy at three different levels, ranging from the cellular to the network and systems level. First, at the cellular level, we describe the relevance of ion channel degeneracy for epilepsy and discuss its interplay with dendritic morphology. Second, at the network level, we provide examples for the degeneracy of synaptic and intrinsic neuronal properties that supports the robustness of neuronal networks but also leads to diverse responses to ictogenic and epileptogenic perturbations. Third, at the system level, we provide examples for degeneracy in the intricate interactions between the immune and nervous system. Finally, we show that computational approaches including multiscale and so called population neural circuit models help disentangle the complex web of physiological and pathological adaptations. Such models may contribute to identifying the best personalized multitarget strategies for directing the system towards a physiological state.

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