Delayed high-frequency suppression after automated single-pulse electrical stimulation identifies the seizure onset zone in patients with refractory epilepsy

2018 ◽  
Vol 129 (11) ◽  
pp. 2466-2474 ◽  
Author(s):  
Tyler S. Davis ◽  
John D. Rolston ◽  
Robert J. Bollo ◽  
Paul A. House
Keyword(s):  
Electrical Stimulation ◽  
High Frequency ◽  
Refractory Epilepsy ◽  
Single Pulse ◽  
Seizure Onset ◽  
Seizure Onset Zone

scholarly journals Interictal high frequency background activity as a biomarker of epileptogenic tissue

2021 ◽  
Author(s):  
Truman Stovall ◽  
Brian Hunt ◽  
Simon Glynn ◽  
William C Stacey ◽  
Stephen V Gliske
Keyword(s):  
Logistic Regression ◽  
Confidence Interval ◽  
High Frequency ◽  
High Frequency Oscillation ◽  
Epileptogenic Zone ◽  
Odds Ratios ◽  
Seizure Onset ◽  
High Frequency Oscillations ◽  
Seizure Onset Zone ◽  
Background Data

Abstract High Frequency Oscillations are very brief events that are a well-established biomarker of the epileptogenic zone, but are rare and comprise only a tiny fraction of the total recorded EEG. We hypothesize that the interictal high frequency “background” data, which has received little attention but represents the majority of the EEG record, also may contain additional, novel information for identifying the epileptogenic zone. We analyzed intracranial EEG (30–500 Hz frequency range) acquired from 24 patients who underwent resective surgery. We computed 38 quantitative features based on all usable, interictal data (63–307 hours per subject), excluding all detected high frequency oscillations. We assessed association between each feature and the seizure onset zone and resected volume using logistic regression. A pathology score per channel was also created via principle component analysis and logistic regression, using hold-out-one-patient cross validation to avoid in-sample training. Association of the pathology score with the seizure onset zone and resected volume was quantified using an asymmetry measure. Many features were associated with the seizure onset zone: 23/38 features had odds ratios >1.3 or < 0.7 and 17/38 had odds ratios different than zero with high significance (p < 0.001/39, logistic regression with Bonferroni Correction). The pathology score, the rate of high frequency oscillations, and their channel-wise product were each strongly associated with the seizure onset zone (median asymmetry > =0.44, good surgery outcome patients; median asymmetry > =0.40, patients with other outcomes; 95% confidence interval > 0.27 in both cases). The pathology score and the channel-wise product also had higher asymmetry with respect to the seizure onset zone than the high frequency oscillation rate alone (median difference in asymmetry > =0.18, 95% confidence interval >0.05). These results support that the high frequency background data contains useful information for determining the epileptogenic zone, distinct and complementary to information from detected high frequency oscillations. The concordance between the high frequency activity pathology score and the rate of high frequency oscillations appears to be a better biomarker of epileptic tissue than either measure alone.

scholarly journals The Connectivity Index: An Effective Metric for Grading Epileptogenicity

2019 ◽  
Author(s):  
Qi Yan ◽  
Nicolas Gaspard ◽  
Hitten P Zaveri ◽  
Hal Blumenfeld ◽  
Lawrence J. Hirsch ◽  
...  
Keyword(s):  
Average Distance ◽  
Single Pulse ◽  
Brain Regions ◽  
Control Site ◽  
Connectivity Index ◽  
Evoked Responses ◽  
Seizure Onset ◽  
Seizure Onset Zone ◽  
Site Of Stimulation ◽  
Stimulation Of

AbstractObjectiveTo investigate the performance of a metric of functional connectivity to classify and grade the excitability of brain regions based on evoked potentials to single pulse electrical stimulation (SPES).MethodsPatients who received 1-Hz frequency stimulation between 2003 and 2014 at Yale at prospectively selected contacts were included. The stimulated contacts were classified as seizure onset zone (SOZ), highly irritative zone (IZp) or control. Response contacts were classified as seizure onset zone (SOZ), active interictal (IZp), quiet or other. The normalized number of responses was defined as the number of contacts with any evoked responses divided by the total number of recorded contacts, and the normalized distance is the ratio of the average distance between the site of stimulation and sites of evoked responses to the average distances between the site of stimulation and all other recording contacts. A new metric we labeled the connectivity index (CI) is defined as the product of the two values.Results57 stimulation-sessions in 22-patients were analyzed. The connectivity index (CI) of the SOZ was higher than control (median CI of 0.74 vs. 0.16, p = 0.0002). The evoked responses after stimulation of SOZ were seen at further distance compared to control (median normalized distance 0.96 vs. 0.62, p = 0.0005). It was 1.8 times more likely to record a response at SOZ than in non-epileptic contacts after stimulation of a control site. Habitual seizures were triggered in 27% of patients and 35 % of SOZ contacts (median stimulation intensity 4 mA) but in none of the control or IZp contacts. Non-SOZ contacts in multifocal or poor surgical outcome cases had a higher CI than non-SOZ contacts in those with localizable onsets (medians CI of 0.5 vs. 0.12, p = 0.04). There was a correlation between the stimulation current intensity and the normalized number of evoked responses (r = + 0.49, p 0.01) but not with distance (r = + 0.1, p 0.64)ConclusionsWe found enhanced connectivity when stimulating the SOZ compared to stimulating control contacts; responses were more distant as well. Habitual auras and seizures provoked by SPES were highly predictive of brain sites involved in seizure generation.

scholarly journals Patient-specific optimization of automated detection improves seizure onset zone localization based on high frequency oscillations

2020 ◽  
Author(s):  
Casey L. Trevino ◽  
Jack J. Lin ◽  
Indranil Sen-Gupta ◽  
Beth A. Lopour
Keyword(s):  
High Frequency ◽  
Classification Accuracy ◽  
Patient Specific ◽  
Seizure Onset ◽  
Data Set ◽  
Localization Accuracy ◽  
High Frequency Oscillations ◽  
Seizure Onset Zone ◽  
Wide Range ◽  
The Impact

AbstractHigh frequency oscillations (HFOs) are a promising biomarker of epileptogenicity, and automated algorithms are critical tools for their detection. However, previously validated algorithms often exhibit decreased HFO detection accuracy when applied to a new data set, if the parameters are not optimized. This likely contributes to decreased seizure localization accuracy, but this has never been tested. Therefore, we evaluated the impact of parameter selection on seizure onset zone (SOZ) localization using automatically detected HFOs. We detected HFOs in intracranial EEG from twenty medically refractory epilepsy patients with seizure free surgical outcomes using an automated algorithm. For each patient, we assessed classification accuracy of channels inside/outside the SOZ using a wide range of detection parameters and identified the parameters associated with maximum classification accuracy. We found that only three out of twenty patients achieved maximal localization accuracy using conventional HFO detection parameters, and optimal parameter ranges varied significantly across patients. The parameters for amplitude threshold and root-mean-square window had the greatest impact on SOZ localization accuracy; minimum event duration and rejection of false positive events did not significantly affect the results. Using individualized optimal parameters led to substantial improvements in localization accuracy, particularly in reducing false positives from non-SOZ channels. We conclude that optimal HFO detection parameters are patient-specific, often differ from conventional parameters, and have a significant impact on SOZ localization. This suggests that individual variability should be considered when implementing automatic HFO detection as a tool for surgical planning.

scholarly journals Spatial variation in high-frequency oscillation rates and amplitudes in intracranial EEG

Neurology ◽  
2018 ◽  
Vol 90 (8) ◽  
pp. e639-e646 ◽  
Author(s):  
Hari Guragain ◽  
Jan Cimbalnik ◽  
Matt Stead ◽  
David M. Groppe ◽  
Brent M. Berry ◽  
...  
Keyword(s):  
High Frequency ◽  
Anatomic Variation ◽  
Brain Regions ◽  
Brain Atlas ◽  
Reproducible Research ◽  
High Frequency Oscillation ◽  
Seizure Onset ◽  
Frequency Oscillation ◽  
Intracranial Eeg ◽  
Seizure Onset Zone

ObjectiveTo assess the variation in baseline and seizure onset zone interictal high-frequency oscillation (HFO) rates and amplitudes across different anatomic brain regions in a large cohort of patients.MethodsSeventy patients who had wide-bandwidth (5 kHz) intracranial EEG (iEEG) recordings during surgical evaluation for drug-resistant epilepsy between 2005 and 2014 who had high-resolution MRI and CT imaging were identified. Discrete HFOs were identified in 2-hour segments of high-quality interictal iEEG data with an automated detector. Electrode locations were determined by coregistering the patient's preoperative MRI with an X-ray CT scan acquired immediately after electrode implantation and correcting electrode locations for postimplant brain shift. The anatomic locations of electrodes were determined using the Desikan-Killiany brain atlas via FreeSurfer. HFO rates and mean amplitudes were measured in seizure onset zone (SOZ) and non-SOZ electrodes, as determined by the clinical iEEG seizure recordings. To promote reproducible research, imaging and iEEG data are made freely available (msel.mayo.edu).ResultsBaseline (non-SOZ) HFO rates and amplitudes vary significantly in different brain structures, and between homologous structures in left and right hemispheres. While HFO rates and amplitudes were significantly higher in SOZ than non-SOZ electrodes when analyzed regardless of contact location, SOZ and non-SOZ HFO rates and amplitudes were not separable in some lobes and structures (e.g., frontal and temporal neocortex).ConclusionsThe anatomic variation in SOZ and non-SOZ HFO rates and amplitudes suggests the need to assess interictal HFO activity relative to anatomically accurate normative standards when using HFOs for presurgical planning.

scholarly journals DC shifts, high frequency oscillations, ripples and fast ripples in relation to the seizure onset zone

Seizure ◽  
2020 ◽  
Vol 77 ◽  
pp. 52-58 ◽  
Author(s):  
Somin Lee ◽  
Naoum P. Issa ◽  
Sandra Rose ◽  
James X. Tao ◽  
Peter C. Warnke ◽  
...  
Keyword(s):  
High Frequency ◽  
Seizure Onset ◽  
High Frequency Oscillations ◽  
Seizure Onset Zone
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