Ictal propagation of high frequency activity is recapitulated in interictal recordings: effective connectivity of epileptogenic networks recorded with intracranial EEG

Preictal connectivity dynamics: Exploring inflow and outflow in iEEG networks

Introduction

Focal resective surgery can be an effective treatment option for patients with refractory epilepsy if the seizure onset zone is accurately identied through intracranial EEG recordings. The traditional concept of the epileptogenic zone has expanded to the notion of an epileptogenic network, emphasizing the role of interconnected brain regions in seizure generation. Precise delineation of this network is essential for optimizing surgical outcomes. Over the past 3 decades, several quantitative connectivity methods have been developed to study the interactions between the seizure onset zone and non-involved regions. Despite these advances, the mechanisms governing the transition from interictal to ictal periods remain poorly understood. In this study, we investigated preictal interactions between the seizure onset zone and the broader network using directed connectivity measures.

Methods

We evaluated their effectiveness in identifying seizure onset zones using a multicenter intracranial EEG dataset, encompassing 243 seizures from 61 patients. Directed transfer function and partial directed coherence were used to extract connectivity matrices during 28-seconds of preictal period in patients with good surgery outcomes. Inflow and outflow metrics were computed for iEEG electrode contact annotated as seizure onset zone and the performance of each metric is assessed in disentangling these electrodes from the rest of the network.

Results

We observed two distinct patterns of network connectivity preceding seizure onset. While there was an increase in inflow of information to seizure onset electrodes in one subset of patients, in the other subset, there was a prominent outflow of information from seizure onset electrodes to the rest of the network, suggesting distinct connectivity patterns associated with the seizure onset zone across patients. Further analyses showed that patients who underwent the grid/strip/depth implantation approach exhibited significantly higher area under curve (AUC) than those with electrocorticography (ECoG) or stereo-electroencephalography (sEEG) alone. Finally, examining the influence of lesional vs non-lesional neuroimaging status demonstrated that a greater proportion of high-inflow and high-outflow were lesional.

Conclusion

Our findings reinforce the notion that seizure generation is driven by dynamic shifts in information flow within the brain's functional network. The preictal connectivity patterns observed --either increased inflow to the seizure onset zone or high outflow from it --underscore the network reorganization involved in epileptic transitions. These results emphasize epilepsy as a network-level phenomenon, supporting the use of network concepts for better understanding seizure dynamics and improving surgical localization strategies.

Interictal epileptiform discharge-related BOLD responses in the default mode network and subcortical regions

OBJECTIVE

To examine the blood oxygen level-dependent (BOLD) responses in the default mode network (DMN) and subcortical regions in relation to epileptic events in scalp EEG and intracranial EEG (iEEG).

METHODS

We retrospectively compared BOLD responses in the DMN and subcortical regions to interictal epileptiform discharge (IED) characteristics of the scalp and iEEG in consecutive patients with focal epilepsy. All voxels were used as the denominator to assess the positive and negative BOLD ratios in each region, and the percentage of voxels with significant activation or deactivation was assessed.

RESULTS

Seventy-one EEG-fMRI studies were included. The widespread IED group showed a higher negative BOLD ratio in the DMN than did the focal IED group. Spike and ripple spreads in iEEG positively correlated with a positive BOLD ratio in the DMN and subcortical regions and a negative BOLD ratio in the DMN. Fast ripple spread showed no correlation with the BOLD ratio in any region.

CONCLUSIONS

IEDs affect local regions, as well as distant neocortical (DMN) and subcortical regions, depending on their localization and characteristics.

SIGNIFICANCE

Our findings showed both positive and negative IED-related BOLD responses in subcortical regions and new evidence of network dysfunction related to focal epileptic activity.

The part and the whole: how single nodes contribute to large-scale phase-locking in functional EEG networks

OBJECTIVE

The application of signal analysis techniques to electroencephalographic (EEG) recordings from epilepsy patients shows that epilepsy involves not only altered neuronal synchronization but also the reorganization of functional EEG networks. This study aims to assess the large-scale phase-locking of such functional networks and how individual network nodes contribute to this collective dynamics.

METHODS

We analyze the EEG recorded before, during and after seizures from sixteen patients with pharmacoresistant focal-onset epilepsy. The data is filtered to low (4-30 Hz) and high (80-150 Hz) frequencies. We define the multivariate phase-locking measure and the univariate phase-locking contribution measure. Surrogate signals are used to estimate baseline results expected under the null hypothesis that the EEG is a correlated linear stochastic process.

RESULTS

On average, nodes from inside and outside the seizure onset zone (SOZ) increase and decrease, respectively, the large-scale phase-locking. This difference becomes most evident in a joint analysis of low and high frequencies.

CONCLUSIONS

Nodes inside and outside the SOZ play opposite roles for the large-scale phase-locking in functional EEG network in epilepsy patients.

SIGNIFICANCE

The application of the phase-locking contribution measure to EEG recordings from epilepsy patients can potentially help in localizing the SOZ.

Networks through the lens of high-frequency oscillations

To date, there is no neurophysiologic or neuroimaging biomarker that can accurately delineate the epileptogenic network. High-frequency oscillations (HFO) have been proposed as biomarkers for epileptogenesis and the epileptogenic network. The pathological HFO have been associated with areas of seizure onset and epileptogenic tissue. Several studies have demonstrated that the resection of areas with high rates of pathological HFO is associated with favorable postoperative outcomes. Recent studies have demonstrated the spatiotemporal organization of HFO into networks and their potential role in defining epileptogenic networks. Our review will present the existing literature on HFO-associated networks, specifically focusing on their role in defining epileptogenic networks and their potential significance in surgical planning.

Modeling the Interictal Epileptic State for Therapeutic Development with Tetanus Toxin

Focal forms of epilepsy can result from a wide range of insults and can vary from focal symptoms to generalized convulsions. Most drugs that have been developed for epilepsy focus on the prevention of seizures. On Electroencephalography (EEG), seizures are characterized by a repetitive buildup of epileptic waveforms that can spread across the brain. Brain regions that produce seizures generate far more frequent 'interictal' spikes seen between seizures, and in animal models, these spikes occur prior to the development of seizures. Interictal spiking by itself has been shown to have significant adverse clinical effects on cognition and behavior in both patients and animal models. While the exact relationships between interictal spiking and seizures are not well defined, interictal spikes serve as an important biomarker that, for some forms of epilepsy, can serve as a surrogate biomarker and as a druggable target. While there are many animal models of seizures for drug development, here we review models of interictal spiking, focusing on tetanus toxin, to study the relationship between interictal spiking, seizures, cognition, and behavior. Studies on human cortical regions with frequent interictal spiking have identified potential therapeutic targets; therefore, having a highly consistent model of spiking will be invaluable not only for unraveling the initial stages of the pathological cascade leading to seizure development but also for testing novel therapeutics. This review offers a succinct overview of the use of tetanus toxin animal models for studying and therapeutic development for interictal spiking.

Graph theoretical brain connectivity measures to investigate neural correlates of music rhythms associated with fear and anger

The present study tests the hypothesis that emotions of fear and anger are associated with distinct psychophysiological and neural circuitry according to discrete emotion model due to contrasting neurotransmitter activities, despite being included in the same affective group in many studies due to similar arousal-valance scores of them in emotion models. EEG data is downloaded from OpenNeuro platform with access number of ds002721. Brain connectivity estimations are obtained by using both functional and effective connectivity estimators in analysis of short (2 sec) and long (6 sec) EEG segments across the cortex. In tests, discrete emotions and resting-states are identified by frequency band specific brain network measures and then contrasting emotional states are deep classified with 5-fold cross-validated Long Short Term Memory Networks. Logistic regression modeling has also been examined to provide robust performance criteria. Commonly, the best results are obtained by using Partial Directed Coherence in Gamma (31.5 - 60.5 H z ) sub-bands of short EEG segments. In particular, Fear and Anger have been classified with accuracy of 91.79%. Thus, our hypothesis is supported by overall results. In conclusion, Anger is found to be characterized by increased transitivity and decreased local efficiency in addition to lower modularity in Gamma-band in comparison to fear. Local efficiency refers functional brain segregation originated from the ability of the brain to exchange information locally. Transitivity refer the overall probability for the brain having adjacent neural populations interconnected, thus revealing the existence of tightly connected cortical regions. Modularity quantifies how well the brain can be partitioned into functional cortical regions. In conclusion, PDC is proposed to graph theoretical analysis of short EEG epochs in presenting robust emotional indicators sensitive to perception of affective sounds.

Physiological and pathological neuronal connectivity in the living human brain based on intracranial EEG signals: the current state of research

Over the past decades, studies of human brain networks have received growing attention as the assessment and modelling of connectivity in the brain is a topic of high impact with potential application in the understanding of human brain organization under both physiological as well as various pathological conditions. Under specific diagnostic settings, human neuronal signal can be obtained from intracranial EEG (iEEG) recording in epilepsy patients that allows gaining insight into the functional organisation of living human brain. There are two approaches to assess brain connectivity in the iEEG-based signal: evaluation of spontaneous neuronal oscillations during ongoing physiological and pathological brain activity, and analysis of the electrophysiological cortico-cortical neuronal responses, evoked by single pulse electrical stimulation (SPES). Both methods have their own advantages and limitations. The paper outlines available methodological approaches and provides an overview of current findings in studies of physiological and pathological human brain networks, based on intracranial EEG recordings.

Spike propagation mapping reveals effective connectivity and predicts surgical outcome in epilepsy

Neurosurgical intervention is the best available treatment for selected patients with drug resistant epilepsy. For these patients, surgical planning requires biomarkers that delineate the epileptogenic zone, the brain area that is indispensable for the generation of seizures. Interictal spikes recorded with electrophysiological techniques are considered key biomarkers of epilepsy. Yet, they lack specificity, mostly because they propagate across brain areas forming networks. Understanding the relationship between interictal spike propagation and functional connections among the involved brain areas may help develop novel biomarkers that can delineate the epileptogenic zone with high precision. Here, we reveal the relationship between spike propagation and effective connectivity among onset and areas of spread and assess the prognostic value of resecting these areas. We analysed intracranial EEG data from 43 children with drug resistant epilepsy who underwent invasive monitoring for neurosurgical planning. Using electric source imaging, we mapped spike propagation in the source domain and identified three zones: onset, early-spread and late-spread. For each zone, we calculated the overlap and distance from surgical resection. We then estimated a virtual sensor for each zone and the direction of information flow among them via Granger causality. Finally, we compared the prognostic value of resecting these zones, the clinically-defined seizure onset zone and the spike onset on intracranial EEG channels by estimating their overlap with resection. We observed a spike propagation in source space for 37 patients with a median duration of 95 ms (interquartile range: 34-206), a spatial displacement of 14 cm (7.5-22 cm) and a velocity of 0.5 m/s (0.3-0.8 m/s). In patients with good surgical outcome (25 patients, Engel I), the onset had higher overlap with resection [96% (40-100%)] than early-spread [86% (34-100%), P = 0.01] and late-spread [59% (12-100%), P = 0.002], and it was also closer to resection than late-spread [5 mm versus 9 mm, P = 0.007]. We found an information flow from onset to early-spread in 66% of patients with good outcomes, and from early-spread to onset in 50% of patients with poor outcome. Finally, resection of spike onset, but not area of spike spread or the seizure onset zone, predicted outcome with positive predictive value of 79% and negative predictive value of 56% (P = 0.04). Spatiotemporal mapping of spike propagation reveals information flow from onset to areas of spread in epilepsy brain. Surgical resection of the spike onset disrupts the epileptogenic network and may render patients with drug resistant epilepsy seizure-free without having to wait for a seizure to occur during intracranial monitoring.

SEEG-based reevaluation of epileptogenic networks and the predictive role for reoperation in MTLE patients with surgical failure

OBJECTIVE

Approximately 20%-30% of mesial temporal lobe epilepsy (MTLE) patients got unfavorable seizure control after surgery, and there was a discrepancy about the reasons for the surgical failure. The functional connectivity (FC) patterns obtained from stereo-electroencephalography (SEEG) reveal information about the dynamics of the epileptic brain and the added value of extracting information that was not identifiable in the SEEG data using FC analysis. This study aims to find out the patterns of the potential epileptogenic network of failure patients and the electrophysiological predictors of reoperation.

METHODS

From January 2012 to December 2019, the MTLE patients with surgical failure were reviewed, and all patients underwent SEEG-guided reoperation. The epileptogenic network was quantified by calculating FC indicators, including phase slope index (PSI), mutual information (MI) strength, imaginary coherence (icoh), and Granger causality.

RESULTS

Ten patients with 13 seizures were included in the analysis, and 7 of them achieved a favorable outcome after the SEEG-guided reoperation. The surgical zone (SZ) with a favorable prognosis showed greater outward information flow than the non-SZ, whereas the SZ with an unfavorable prognosis showed greater inward information flow. The recurrent patients with favorable prognosis had strong connectivity between the posterior hippocampus, temporal neocortex, and insula, whereas the patients with unfavorable prognosis showed strong functional connectivity between the insula and temporal-parietal-occipital junction. The power spectrum of patients with favorable prognosis was significantly lower than that of patients with unfavorable prognosis, especially showing a more oscillation power of low frequency.

SIGNIFICANCE

The SEEG-guided reoperation could achieve favorable seizure control outcomes for recurrent patients. The FCs were a potential indicator to help construct the temporal epileptic network and predictor for the reoperative prognosis in the recurrent patients.

Quantitative approaches to guide epilepsy surgery from intracranial EEG

Over the past 10 years, the drive to improve outcomes from epilepsy surgery has stimulated widespread interest in methods to quantitatively guide epilepsy surgery from intracranial EEG (iEEG). Many patients fail to achieve seizure freedom, in part due to the challenges in subjective iEEG interpretation. To address this clinical need, quantitative iEEG analytics have been developed using a variety of approaches, spanning studies of seizures, interictal periods, and their transitions, and encompass a range of techniques including electrographic signal analysis, dynamical systems modeling, machine learning and graph theory. Unfortunately, many methods fail to generalize to new data and are sensitive to differences in pathology and electrode placement. Here, we critically review selected literature on computational methods of identifying the epileptogenic zone from iEEG. We highlight shared methodological challenges common to many studies in this field and propose ways that they can be addressed. One fundamental common pitfall is a lack of open-source, high-quality data, which we specifically address by sharing a centralized high-quality, well-annotated, multicentre dataset consisting of >100 patients to support larger and more rigorous studies. Ultimately, we provide a road map to help these tools reach clinical trials and hope to improve the lives of future patients.

Investigation of global brain dynamics depending on emotion regulation strategies indicated by graph theoretical brain network measures at system level

In the present study, new findings reveal the close association between graph theoretic global brain connectivity measures and cognitive abilities the ability to manage and regulate negative emotions in healthy adults. Functional brain connectivity measures have been estimated from both eyes-opened and eyes-closed resting-state EEG recordings in four groups including individuals who use opposite Emotion Regulation Strategies (ERS) as follow: While 20 individuals who frequently use two opposing strategies, such as rumination and cognitive distraction, are included in 1st group, 20 individuals who don't use these cognitive strategies are included in 2nd group. In 3rd and 4th groups, there are matched individuals who use both Expressive Suppression and Cognitive Reappraisal strategies together frequently and never use them, respectively. EEG measurements and psychometric scores of individuals were both downloaded from a public dataset LEMON. Since it is not sensitive to volume conduction, Directed Transfer Function has been applied to 62-channel recordings to obtain cortical connectivity estimations across the whole cortex. Regarding well defined threshold, connectivity estimations have been transformed into binary numbers for implementation of Brain Connectivity Toolbox. The groups are compared to each other through both statistical logistic regression models and deep learning models driven by frequency band specific network measures referring segregation, integration and modularity of the brain. Overall results show that high classification accuracies of 96.05% (1st vs 2nd) and 89.66% (3rd vs 4th) are obtained in analyzing full-band ( 0.5 - 45 H z ) EEG. In conclusion, negative strategies may upset the balance between segregation and integration. In particular, graphical results show that frequent use of rumination induces the decrease in assortativity referring network resilience. The psychometric scores are found to be highly correlated with brain network measures of global efficiency, local efficiency, clustering coefficient, transitivity and assortativity in even resting-state.

Multilayer brain networks can identify the epileptogenic zone and seizure dynamics

Seizure generation, propagation, and termination occur through spatiotemporal brain networks. In this paper, we demonstrate the significance of large-scale brain interactions in high-frequency (80-200Hz) for the identification of the epileptogenic zone (EZ) and seizure evolution. To incorporate the continuity of neural dynamics, here we have modeled brain connectivity constructed from stereoelectroencephalography (SEEG) data during seizures using multilayer networks. After introducing a new measure of brain connectivity for temporal networks, named multilayer eigenvector centrality (mlEVC), we applied a consensus hierarchical clustering on the developed model to identify the EZ as a cluster of nodes with distinctive brain connectivity in the ictal period. Our algorithm could successfully predict electrodes inside the resected volume as EZ for 88% of participants, who all were seizure-free for at least 12 months after surgery. Our findings illustrated significant and unique desynchronization between EZ and the rest of the brain in the early to mid-seizure. We showed that aging and the duration of epilepsy intensify this desynchronization, which can be the outcome of abnormal neuroplasticity. Additionally, we illustrated that seizures evolve with various network topologies, confirming the existence of different epileptogenic networks in each patient. Our findings suggest not only the importance of early intervention in epilepsy but possible factors that correlate with disease severity. Moreover, by analyzing the propagation patterns of different seizures, we demonstrate the necessity of collecting sufficient data for identifying epileptogenic networks.

An application of dynamical directed connectivity of ictal intracranial EEG recordings in seizure onset zone localization

BACKGROUND

Identification of the seizure onset zone (SOZ) is a challenging task in epilepsy surgery. Patients with epilepsy have an altered brain network, allowing connectivity-based analyses to have a great potential in SOZ identification. We investigated a dynamical directed connectivity analysis utilizing ictal intracranial electroencephalographic (iEEG) recordings and proposed an algorithm for SOZ identification based on grouping iEEG contacts.

NEW METHODS

Granger Causality was used for directed connectivity analysis in this study. The intracranial contacts were grouped into visually detected contacts (VDCs), which were identified as SOZ by epileptologists, and non-resected contacts (NRCs). The intragroup and intergroup directed connectivity for VDCs and NRCs were calculated around seizure onset. We then proposed an algorithm for SOZ identification based on the cross-correlation of intragroup outflow and inflow of SOZ candidate contacts.

RESULTS

Our results revealed that the intragroup connectivity of VDCs (VDC→VDC) was significantly larger than the intragroup connectivity of NRCs (NRC→NRC) and the intergroup connectivity between NRCs and VDCs (NRC→VDC) around seizure onset. We found that the proposed algorithm had 90.1 % accuracy for SOZ identification in the seizure-free patients.

COMPARISON WITH EXISTING METHODS

The existing connectivity-based methods for SOZ identification often use either outflow or inflow. In this study, SOZ contacts were identified by integrating outflow and inflow based on the cross correlation between these two measures.

CONCLUSIONS

The proposed group-based dynamical connectivity analysis in this study can aid our understanding of underlying seizure network and may be used to assist in identifying the SOZ contacts before epilepsy surgery.

Spike-Associated Networks Predict Postsurgical Outcomes in Children With Refractory Epilepsy

PURPOSE

Up to half of the children undergoing epilepsy surgery will continue to have seizures (szs) despite a cortical resection or ablation. Functional connectivity has shown promise in better identifying the epileptogenic zone. We hypothesized that cortical areas showing high information outflow during interictal epileptiform discharges are part of the epileptogenic zone.

METHODS

We identified 22 children with focal epilepsy who had undergone stereo electroencephalography, surgical resection or ablation, and had ≥1 year of postsurgical follow-up. The mean phase slope index, a directed measure of functional connectivity, was calculated for each electrode contact during interictal epileptiform discharges. The positive predictive value and negative predictive value for a sz-free outcome were calculated based on whether high information outflow brain regions were resected.

RESULTS

Resection of high outflow (z-score ≥ 1) and very high outflow (z-score ≥ 2) electrode contacts was associated with higher sz freedom (high outflow: χ 2 statistic = 59.1; P < 0.001; very high outflow: χ 2 statistic = 31.3; P < 0.001). The positive predictive value and negative predictive value for sz freedom based on resection at the electrode level increased at higher z-score thresholds with a peak positive predictive value of 0.86 and a peak negative predictive value of 0.9.

CONCLUSIONS

Better identification of the epileptogenic zone has the potential to improve epilepsy surgery outcomes. If the surgical plan can be modified to include these very high outflow areas, more children might achieve sz freedom. Conversely, if deficits from resecting these areas are unacceptable, ineffective surgeries could be avoided and alternative therapies offered.

Interictal localization of the epileptogenic zone: Utilizing the observed resonance behavior in the spectral band of surrounding inhibition

Introduction

The gold standard for identification of the epileptogenic zone (EZ) continues to be the visual inspection of electrographic changes around seizures' onset by experienced electroencephalography (EEG) readers. Development of an epileptogenic focus localization tool that can delineate the EZ from analysis of interictal (seizure-free) periods is still an open question of great significance for improved diagnosis (e.g., presurgical evaluation) and treatment of epilepsy (e.g., surgical outcome).

Methods

We developed an EZ interictal localization algorithm (EZILA) based on novel analysis of intracranial EEG (iEEG) using a univariate periodogram-type power measure, a straight-forward ranking approach, a robust dimensional reduction method and a clustering technique. Ten patients with temporal and extra temporal lobe epilepsies, and matching the inclusion criteria of having iEEG recordings at the epilepsy monitoring unit (EMU) and being Engel Class I ≥12 months post-surgery, were recruited in this study.

Results

In a nested k-fold cross validation statistical framework, EZILA assigned the highest score to iEEG channels within the EZ in all patients (10/10) during the first hour of the iEEG recordings and up to their first typical clinical seizure in the EMU (i.e., early interictal period). To further validate EZILA's performance, data from two new (Engel Class I) patients were analyzed in a double-blinded fashion; the EZILA successfully localized iEEG channels within the EZ from interictal iEEG in both patients.

Discussion

Out of the sampled brain regions, iEEG channels in the EZ were most frequently and maximally active in seizure-free (interictal) periods across patients in specific narrow gamma frequency band (∼60-80 Hz), which we have termed focal frequency band (FFB). These findings are consistent with the hypothesis that the EZ may interictally be regulated (controlled) by surrounding inhibitory neurons with resonance characteristics within this narrow gamma band.

Source-sink connectivity: a novel interictal EEG marker for seizure localization

Over 15 million epilepsy patients worldwide have drug-resistant epilepsy. Successful surgery is a standard of care treatment but can only be achieved through complete resection or disconnection of the epileptogenic zone, the brain region(s) where seizures originate. Surgical success rates vary between 20% and 80%, because no clinically validated biological markers of the epileptogenic zone exist. Localizing the epileptogenic zone is a costly and time-consuming process, which often requires days to weeks of intracranial EEG (iEEG) monitoring. Clinicians visually inspect iEEG data to identify abnormal activity on individual channels occurring immediately before seizures or spikes that occur interictally (i.e. between seizures). In the end, the clinical standard mainly relies on a small proportion of the iEEG data captured to assist in epileptogenic zone localization (minutes of seizure data versus days of recordings), missing opportunities to leverage these largely ignored interictal data to better diagnose and treat patients. IEEG offers a unique opportunity to observe epileptic cortical network dynamics but waiting for seizures increases patient risks associated with invasive monitoring. In this study, we aimed to leverage interictal iEEG data by developing a new network-based interictal iEEG marker of the epileptogenic zone. We hypothesized that when a patient is not clinically seizing, it is because the epileptogenic zone is inhibited by other regions. We developed an algorithm that identifies two groups of nodes from the interictal iEEG network: those that are continuously inhibiting a set of neighbouring nodes ('sources') and the inhibited nodes themselves ('sinks'). Specifically, patient-specific dynamical network models were estimated from minutes of iEEG and their connectivity properties revealed top sources and sinks in the network, with each node being quantified by source-sink metrics. We validated the algorithm in a retrospective analysis of 65 patients. The source-sink metrics identified epileptogenic regions with 73% accuracy and clinicians agreed with the algorithm in 93% of seizure-free patients. The algorithm was further validated by using the metrics of the annotated epileptogenic zone to predict surgical outcomes. The source-sink metrics predicted outcomes with an accuracy of 79% compared to an accuracy of 43% for clinicians' predictions (surgical success rate of this dataset). In failed outcomes, we identified brain regions with high metrics that were untreated. When compared with high frequency oscillations, the most commonly proposed interictal iEEG feature for epileptogenic zone localization, source-sink metrics outperformed in predictive power (by a factor of 1.2), suggesting they may be an interictal iEEG fingerprint of the epileptogenic zone.

The spatial relationship between the MRI lesion and intraoperative electrocorticography in focal epilepsy surgery

MRI and intraoperative electrocorticography are often used in tandem to delineate epileptogenic tissue in resective surgery for focal epilepsy. Both the resection of the MRI lesion and tissue with high rates of electrographic discharges on electrocorticography, e.g. spikes and high-frequency oscillations (80-500 Hz), lead to a better surgical outcome. How MRI and electrographic markers are related, however, is currently unknown. The aim of this study was to find the spatial relationship between MRI lesions and spikes/high-frequency oscillations. We retrospectively included 33 paediatric and adult patients with lesional neocortical epilepsy who underwent electrocorticography-tailored surgery (14 females, median age = 13.4 years, range = 0.6-47.0 years). Mesiotemporal lesions were excluded. We used univariable linear regression to find correlations between pre-resection spike/high-frequency oscillation rates on an electrode and its distance to the MRI lesion. We tested straight lines to the centre and the edge of the MRI lesion, and the distance along the cortical surface to determine which of these distances best reflects the occurrence of spikes/high-frequency oscillations. We conducted a moderator analysis to investigate the influence of the underlying pathology type and lesion volume on our results. We found spike and high-frequency oscillation rates to be spatially linked to the edge of the MRI lesion. The underlying pathology type influenced the spatial relationship between spike/high-frequency oscillation rates and the MRI lesion (P spikes < 0.0001, P ripples < 0.0001), while the lesion volume did not (P spikes = 0.64, P ripples = 0.89). A higher spike rate was associated with a shorter distance to the edge of the lesion for cavernomas [F(1,64) = -1.37, P < 0.0001, η 2 = 0.22], focal cortical dysplasias [F(1,570) = -0.25, P < 0.0001, η 2 = 0.05] and pleomorphic xanthoastrocytomas [F(1,66) = -0.18, P = 0.01, η 2 = 0.09]. In focal cortical dysplasias, a higher ripple rate was associated with a shorter distance [F(1,570) = -0.35, P < 0.0001, η 2 = 0.05]. Conversely, low-grade gliomas showed a positive correlation; the further an electrode was away from the lesion, the higher the rate of spikes [F(1,75) = 0.65, P < 0.0001, η 2 = 0.37] and ripples [F(1,75) = 2.67, P < 0.0001, η 2 = 0.22]. Pathophysiological processes specific to certain pathology types determine the spatial relationship between the MRI lesion and electrocorticography results. In our analyses, non-tumourous lesions (focal cortical dysplasias and cavernomas) seemed to intrinsically generate spikes and high-frequency oscillations, particularly at the border of the lesion. This advocates for a resection of this tissue. Low-grade gliomas caused epileptogenicity in the peritumoural tissue. Whether a resection of this tissue leads to a better outcome is unclear. Our results suggest that the underlying pathology type should be considered when intraoperative electrocorticography is interpreted.

Interictal Connectivity Revealed by Granger Analysis of Stereoelectroencephalography: Association With Ictal Onset Zone, Resection, and Outcome

BACKGROUND

Stereoelectroencephalography (sEEG) facilitates electrical sampling and evaluation of complex deep-seated, dispersed, and multifocal locations. Granger causality (GC), previously used to study seizure networks using interictal data from subdural grids, may help identify the seizure-onset zone from interictal sEEG recordings.

OBJECTIVE

To examine whether statistical analysis of interictal sEEG helps identify surgical target sites and whether surgical resection of highly ranked nodes correspond to favorable outcomes.

METHODS

Ten minutes of extraoperative recordings from sequential patients who underwent sEEG evaluation were analyzed (n = 20). GC maps were compared with clinically defined surgical targets using rank order statistics. Outcomes of patients with focal resection/ablation with median follow-up of 3.6 years were classified as favorable (Engel 1, 2) or poor (Engel 3, 4) to assess their relationship with the removal of highly ranked nodes using the Wilcoxon rank-sum test.

RESULTS

In 12 of 20 cases, the rankings of contacts (based on the sum of outward connection weights) mapped to the seizure-onset zone showed higher causal node connectivity than predicted by chance ( P ≤ .02). A very low aggregate probability ( P < 10 -18 , n = 20) suggests that causal node connectivity predicts seizure networks. In 8 of 16 with outcome data, causal connectivity in the resection was significantly greater than in the remaining contacts ( P ≤ .05). We found a significant association between favorable outcome and the presence of highly ranked nodes in the resection ( P < .05).

CONCLUSION

Granger analysis can identify seizure foci from interictal sEEG and correlates highly ranked nodes with favorable outcome, potentially informing surgical decision-making without reliance on ictal recordings.

High-Frequency Oscillations and Epileptogenic Network

Epilepsy is a network disease caused by aberrant neocortical large-scale connectivity spanning regions on the scale of several centimeters. High-frequency oscillations, characterized by the 80-600 Hz signals in electroencephalography, have been proven to be a promising biomarker of epilepsy that can be used in assessing the severity and susceptibility of epilepsy as well as the location of the epileptogenic zone. However, the presence of a high-frequency oscillation network remains a topic of debate as high-frequency oscillations have been previously thought to be incapable of propagation, and the relationship between high-frequency oscillations and the epileptogenic network has rarely been discussed. Some recent studies reported that high-frequency oscillations may behave like networks that are closely relevant to the epileptogenic network. Pathological highfrequency oscillations are network-driven phenomena and elucidate epileptogenic network development; high-frequency oscillations show different characteristics coincident with the epileptogenic network dynamics, and cross-frequency coupling between high-frequency oscillations and other signals may mediate the generation and propagation of abnormal discharges across the network.

Phase irregularity: A conceptually simple and efficient approach to characterize electroencephalographic recordings from epilepsy patients

The severe neurological disorder epilepsy affects almost 1% of the world population. For patients who suffer from pharmacoresistant focal-onset epilepsy, electroencephalographic (EEG) recordings are essential for the localization of the brain area where seizures start. Apart from the visual inspection of the recordings, quantitative EEG signal analysis techniques proved to be useful for this purpose. Among other features, regularity versus irregularity and phase coherence versus phase independence allowed characterizing brain dynamics from the measured EEG signals. Can phase irregularities also characterize brain dynamics? To address this question, we use the univariate coefficient of phase velocity variation, defined as the ratio of phase velocity standard deviation and the mean phase velocity. Beyond that, as a bivariate measure we use the classical mean phase coherence to quantify the degree of phase locking. All phase-based measures are combined with surrogates to test null hypotheses about the dynamics underlying the signals. In the first part of our analysis, we use the Rössler model system to study our approach under controlled conditions. In the second part, we use the Bern-Barcelona EEG database which consists of focal and nonfocal signals extracted from seizure-free recordings. Focal signals are recorded from brain areas where the first seizure EEG signal changes can be detected, and nonfocal signals are recorded from areas that are not involved in the seizure at its onset. Our results show that focal signals have less phase variability and more phase coherence than nonfocal signals. Once combined with surrogates, the mean phase velocity proved to have the highest discriminative power between focal and nonfocal signals. In conclusion, conceptually simple and easy to compute phase-based measures can help to detect features induced by epilepsy from EEG signals. This holds not only for the classical mean phase coherence but even more so for univariate measures of phase irregularity.

Significance of event related causality (ERC) in eloquent neural networks

Neural activity emerges and propagates swiftly between brain areas. Investigation of these transient large-scale flows requires sophisticated statistical models. We present a method for assessing the statistical confidence of event-related neural propagation. Furthermore, we propose a criterion for statistical model selection, based on both goodness of fit and width of confidence intervals. We show that event-related causality (ERC) with two-dimensional (2D) moving average, is an efficient estimator of task-related neural propagation and that it can be used to determine how different cognitive task demands affect the strength and directionality of neural propagation across human cortical networks. Using electrodes surgically implanted on the surface of the brain for clinical testing prior to epilepsy surgery, we recorded electrocorticographic (ECoG) signals as subjects performed three naming tasks: naming of ambiguous and unambiguous visual objects, and as a contrast, naming to auditory description. ERC revealed robust and statistically significant patterns of high gamma activity propagation, consistent with models of visually and auditorily cued word production. Interestingly, ambiguous visual stimuli elicited more robust propagation from visual to auditory cortices relative to unambiguous stimuli, whereas naming to auditory description elicited propagation in the opposite direction, consistent with recruitment of modalities other than those of the stimulus during object recognition and naming. The new method introduced here is uniquely suitable to both research and clinical applications and can be used to estimate the statistical significance of neural propagation for both cognitive neuroscientific studies and functional brain mapping prior to resective surgery for epilepsy and brain tumors.

Transfer Entropy between Intracranial EEG Nodes Highlights Network Dynamics that Cause and Stop Epileptic Seizures

Transfer entropy (TE) is used to examine the connectivity between nodes and the roles of nodes in epileptic neural networks during rest, moments before seizure, during seizure, and moments after seizure. There is a set of nodes that dominate information flow to epileptogenic zone (EZ) nodes, regions that trigger seizure, and non-EZ nodes during rest. The TE from the dominant to the EZ nodes decreases shortly before a seizure event and reaches a minimum during seizure. During the seizure, the dominant nodes cease or only weakly interact with the EZ nodes. This supports the hypothesis that seizure occurs when some nodes stop inhibiting the EZ nodes. The TE from the dominant to the EZ nodes peaks immediately after seizure, suggesting that seizure may stop when the brain exerts the highest level of information flow/activation/communication to the EZ nodes. The information flow from the dominant to EZ nodes is different from that to non-EZ nodes. This TE dynamics entering and exiting seizures may identify more accurately the EZ nodes, which may improve surgical planning.

Ictal gamma-band interactions localize ictogenic nodes of the epileptic network in focal cortical dysplasia

OBJECTIVE

Epilepsy surgery fails in > 30% of patients with focal cortical dysplasia (FCD). The seizure persistence after surgery can be attributed to the inability to precisely localize the tissue with an endogenous potential to generate seizures. In this study, we aimed to identify the critical components of the epileptic network that were actively involved in seizure genesis.

METHODS

The directed transfer function was applied to intracranial EEG recordings and the effective connectivity was determined with a high temporal and frequency resolution. Pre-ictal network properties were compared with ictal epochs to identify regions actively generating ictal activity and discriminate them from the areas of propagation.

RESULTS

Analysis of 276 seizures from 30 patients revealed the existence of a seizure-related network reconfiguration in the gamma-band (25-170 Hz; p < 0.005) - ictogenic nodes. Unlike seizure onset zone, resecting the majority of ictogenic nodes correlated with favorable outcomes (p < 0.012).

CONCLUSION

The prerequisite to successful epilepsy surgery is the accurate identification of brain areas from which seizures arise. We show that in FCD-related epilepsy, gamma-band network markers can reliably identify and distinguish ictogenic areas in macroelectrode recordings, improve intracranial EEG interpretation and better delineate the epileptogenic zone.

SIGNIFICANCE

Ictogenic nodes localize the critical parts of the epileptogenic tissue and increase the diagnostic yield of intracranial evaluation.

Prediction of Seizure Recurrence. A Note of Caution

Great strides have been made recently in documenting that machine-learning programs can predict seizure occurrence in people who have epilepsy. Along with this progress have come claims that appear to us to be a bit premature. We anticipate that many people will benefit from seizure prediction. We also doubt that all will benefit. Although machine learning is a useful tool for aiding discovery, we believe that the greatest progress will come from deeper understanding of seizures, epilepsy, and the EEG features that enable seizure prediction. In this essay, we lay out reasons for optimism and skepticism.

Rapidly spreading seizures arise from large-scale functional brain networks in focal epilepsy

It remains unclear whether epileptogenic networks in focal epilepsy develop on physiological networks. This work aimed to explore the association between the rapid spread of ictal fast activity (IFA), a proposed biomarker for epileptogenic networks, and the functional connectivity or networks of healthy subjects. We reviewed 45 patients with focal epilepsy who underwent electrocorticographic (ECoG) recordings to identify the patients showing the rapid spread of IFA. IFA power was quantified as normalized beta-gamma band power. Using published resting-state functional magnetic resonance imaging databases, we estimated resting-state functional connectivity of healthy subjects (RSFC-HS) and resting-state networks of healthy subjects (RSNs-HS) at the locations corresponding to the patients' electrodes. We predicted the IFA power of each electrode based on RSFC-HS between electrode locations (RSFC-HS-based prediction) using a recently developed method, termed activity flow mapping. RSNs-HS were identified using seed-based and atlas-based methods. We compared IFA power with RSFC-HS-based prediction or RSNs-HS using non-parametric correlation coefficients. RSFC and seed-based RSNs of each patient (RSFC-PT and seed-based RSNs-PT) were also estimated using interictal ECoG data and compared with IFA power in the same way as RSFC-HS and seed-based RSNs-HS. Spatial autocorrelation-preserving randomization tests were performed for significance testing. Nine patients met the inclusion criteria. None of the patients had reflex seizures. Six patients showed pathological evidence of a structural etiology. In total, we analyzed 49 seizures (2-13 seizures per patient). We observed significant correlations between IFA power and RSFC-HS-based prediction, seed-based RSNs-HS, or atlas-based RSNs-HS in 28 (57.1%), 21 (42.9%), and 28 (57.1%) seizures, respectively. Thirty-two (65.3%) seizures showed a significant correlation with either seed-based or atlas-based RSNs-HS, but this ratio varied across patients: 27 (93.1%) of 29 seizures in six patients correlated with either of them. Among atlas-based RSNs-HS, correlated RSNs-HS with IFA power included the default mode, control, dorsal attention, somatomotor, and temporal-parietal networks. We could not obtain RSFC-PT and RSNs-PT in one patient due to frequent interictal epileptiform discharges. In the remaining eight patients, most of the seizures showed significant correlations between IFA power and RSFC-PT-based prediction or seed-based RSNs-PT. Our study provides evidence that the rapid spread of IFA in focal epilepsy can arise from physiological RSNs. This finding suggests an overlap between epileptogenic and functional networks, which may explain why functional networks in patients with focal epilepsy frequently disrupt.

Seizure Onset Zone Lateralization Using a Non-linear Analysis of Micro vs. Macro Electroencephalographic Recordings During Seizure-Free Stages of the Sleep-Wake Cycle From Epilepsy Patients

The application of non-linear signal analysis techniques to biomedical data is key to improve our knowledge about complex physiological and pathological processes. In particular, the use of non-linear techniques to study electroencephalographic (EEG) recordings can provide an advanced characterization of brain dynamics. In epilepsy these dynamics are altered at different spatial scales of neuronal organization. We therefore apply non-linear signal analysis to EEG recordings from epilepsy patients derived with intracranial hybrid electrodes, which are composed of classical macro contacts and micro wires. Thereby, these electrodes record EEG at two different spatial scales. Our aim is to test the degree to which the analysis of the EEG recorded at these different scales allows us to characterize the neuronal dynamics affected by epilepsy. For this purpose, we retrospectively analyzed long-term recordings performed during five nights in three patients during which no seizures took place. As a benchmark we used the accuracy with which this analysis allows determining the hemisphere that contains the seizure onset zone, which is the brain area where clinical seizures originate. We applied the surrogate-corrected non-linear predictability score (ψ), a non-linear signal analysis technique which was shown previously to be useful for the lateralization of the seizure onset zone from classical intracranial EEG macro contact recordings. Higher values of ψ were found predominantly for signals recorded from the hemisphere containing the seizure onset zone as compared to signals recorded from the opposite hemisphere. These differences were found not only for the EEG signals recorded with macro contacts, but also for those recorded with micro wires. In conclusion, the information obtained from the analysis of classical macro EEG contacts can be complemented by the one of micro wire EEG recordings. This combined approach may therefore help to further improve the degree to which quantitative EEG analysis can contribute to the diagnostics in epilepsy patients.

Interictal intracranial electroencephalography for predicting surgical success: The importance of space and time

Objective

Predicting postoperative seizure freedom using functional correlation networks derived from interictal intracranial electroencephalography (EEG) has shown some success. However, there are important challenges to consider: (1) electrodes physically closer to each other naturally tend to be more correlated, causing a spatial bias; (2) implantation location and number of electrodes differ between patients, making cross-subject comparisons difficult; and (3) functional correlation networks can vary over time but are currently assumed to be static.

Methods

In this study, we address these three challenges using intracranial EEG data from 55 patients with intractable focal epilepsy. Patients additionally underwent preoperative magnetic resonance imaging (MRI), intraoperative computed tomography, and postoperative MRI, allowing accurate localization of electrodes and delineation of the removed tissue.

Results

We show that normalizing for spatial proximity between nearby electrodes improves prediction of postsurgery seizure outcomes. Moreover, patients with more extensive electrode coverage were more likely to have their outcome predicted correctly (area under the receiver operating characteristic curve > 0.9, P « 0.05) but not necessarily more likely to have a better outcome. Finally, our predictions are robust regardless of the time segment analyzed.

Significance

Future studies should account for the spatial proximity of electrodes in functional network construction to improve prediction of postsurgical seizure outcomes. Greater coverage of both removed and spared tissue allows for predictions with higher accuracy.

Model-based design for seizure control by stimulation

OBJECTIVE

Current brain stimulation paradigms are largely empirical rather than theoretical. An opportunity exists to improve upon their modest effectiveness in closed-loop control strategies with the development of theoretically grounded, model-based designs.

APPROACH

Inspired by this need, here we couple experimental data and mathematical modeling with a control-theoretic strategy for seizure termination. We begin by exercising a dynamical systems approach to model seizures (n = 94) recorded using intracranial EEG (iEEG) from 21 patients with medication-resistant, localization-related epilepsy.

MAIN RESULTS

Although each patient's seizures displayed unique spatial and temporal patterns, their evolution can be parsimoniously characterized by the same model form. Idiosyncracies of the model can inform individualized intervention strategies, specifically in iEEG samples with well-localized seizure onset zones. Temporal fluctuations in the spatial profiles of the oscillatory modes show that seizure onset marks a transition into a regime in which the underlying system supports prolonged rhythmic and focal activity. Based on these observations, we propose a control-theoretic strategy that aims to stabilize ictal activity using static output feedback for linear time-invariant switching systems. Finally, we demonstrate in silico that our proposed strategy allows us to dampen the emerging focal oscillatory sources using only a small set of electrodes.

SIGNIFICANCE

Our integrative study informs the development of modulation and control algorithms for neurostimulation that could improve the effectiveness of implantable, closed-loop anti-epileptic devices.

Changing concepts in presurgical assessment for epilepsy surgery

Candidates for epilepsy surgery must undergo presurgical evaluation to establish whether and how surgical treatment can stop seizures without causing neurological deficits. Various techniques, including MRI, PET, single-photon emission CT, video-EEG, magnetoencephalography and invasive EEG, aim to identify the diseased brain tissue and the involved network. Recent technical and methodological developments, encompassing both advances in existing techniques and new combinations of technologies, are enhancing the ability to define the optimal resection strategy. Multimodal interpretation and predictive computer models are expected to aid surgical planning and patient counselling, and multimodal intraoperative guidance is likely to increase surgical precision. In this Review, we discuss how the knowledge derived from these new approaches is challenging our way of thinking about surgery to stop focal seizures. In particular, we highlight the importance of looking beyond the EEG seizure onset zone and considering focal epilepsy as a brain network disease in which long-range connections need to be taken into account. We also explore how new diagnostic techniques are revealing essential information in the brain that was previously hidden from view.

Multiscale Functional Clustering Reveals Frequency Dependent Brain Organization in Type II Focal Cortical Dysplasia With Sleep Hypermotor Epilepsy

OBJECTIVE

A multiscale functional clustering approach is proposed to investigate the organization of the epileptic networks during different sleep stages and in relation with the occurrence of seizures.

METHOD

Stereo-electroencephalographic signals from seven pharmaco-resistant epileptic patients (focal cortical dysplasia type II) were analyzed. The discrete wavelet transform provided a multiscale framework on which a data-driven functional clustering procedure was applied, based on multivariate measures of integration and mutual information. The most interacting functional clusters (FCs) within the sampled brain areas were extracted.

RESULTS

FCs characterized by strongly integrated activity were observed mostly in the beta and alpha frequency bands, immediately before seizure onset and in deep sleep stages. These FCs generally included the electrodes from the epileptogenic zone. Furthermore, repeatable patterns were found across ictal events in the same patient.

CONCLUSION

In line with previous studies, our findings provide evidence of the important role of beta and alpha activity in seizures generation and support the relation between epileptic activity and sleep stages.

SIGNIFICANCE

Despite the small number of subjects included in the study, the present results suggest that the proposed multiscale functional clustering approach is a useful tool for the identification of the frequency-dependent mechanisms underlying seizure generation.

Increased gamma and decreased fast ripple connections of epileptic tissue: A high-frequency directed network approach

OBJECTIVE

New insights into high-frequency electroencephalographic activity and network analysis provide potential tools to improve delineation of epileptic tissue and increase the chance of postoperative seizure freedom. Based on our observation of high-frequency oscillations "spreading outward" from the epileptic source, we hypothesize that measures of directed connectivity in the high-frequency range distinguish epileptic from healthy brain tissue.

METHODS

We retrospectively selected refractory epilepsy patients with a malformation of cortical development or tumor World Health Organization grade I/II who underwent epilepsy surgery with intraoperative electrocorticography for tailoring the resection based on spikes. We assessed directed functional connectivity in the theta (4-8 Hz), gamma (30-80 Hz), ripple (80-250 Hz), and fast ripple (FR; 250-500 Hz) bands using the short-time direct directed transfer function, and calculated the total, incoming, and outgoing propagation strength for each electrode. We compared network measures of electrodes covering the resected and nonresected areas separately for patients with good and poor outcome, and of electrodes with and without spikes, ripples, and FRs (group level: paired t test; patient level: Mann-Whitney U test). We selected the measure that could best identify the resected area and channels with epileptic events using the area under the receiver operating characteristic curve, and calculated the positive and negative predictive value, sensitivity, and specificity.

RESULTS

We found higher total and outstrength in the ripple and gamma bands in resected tissue in patients with good outcome (rippletotal : P = .01; rippleout : P = .04; gammatotal : P = .01; gammaout : P = .01). Channels with events showed lower total and instrength, and higher outstrength in the FR band, and higher total and outstrength in the ripple, gamma, and theta bands (FRtotal : P = .05; FRin : P < .01; FRout : P = .02; gammatotal : P < .01; gammain : P = .01; gammaout : P < .01; thetatotal : P = .01; thetaout : P = .01). The total strength in the gamma band was most distinctive at the channel level (positive predictive value [PPV]good  = 74%, PPVpoor  = 43%).

SIGNIFICANCE

Interictally, epileptic tissue is isolated in the FR band and acts as a driver up to the (fast) ripple frequency range. The gamma band total strength seems promising to delineate epileptic tissue intraoperatively.

The seizure onset zone drives state-dependent epileptiform activity in susceptible brain regions

OBJECTIVE

Due to variability in the patterns of propagation of interictal epileptiform discharges (IEDs), qualitative definition of the irritative zone has been challenging. Here, we introduce a quantitative approach toward exploration of the dynamics of IED propagation within the irritative zone.

METHODS

We examined intracranial EEG (iEEG) in nine participants undergoing invasive monitoring for seizure localization. We used an automated IED detector and a community detection algorithm to identify populations of electrodes exhibiting IED activity that co-occur in time, and to group these electrodes into communities.

RESULTS

Within our algorithmically-identified communities, IED activity in the seizure onset zone (SOZ) tended to lead IED activity in other functionally coupled brain regions. The tendency of pathological activity to arise in the SOZ, and to spread to non-SOZ tissues, was greater in the asleep state.

CONCLUSIONS

IED activity, and, by extension, the variability observed between the asleep and awake states, is propagated from a core seizure focus to nearby less pathological brain regions.

SIGNIFICANCE

Using an unsupervised, computational approach, we show that the spread of IED activity through the epilepsy network varies with physiologic state.

High Frequency Oscillations in Epilepsy: Detection Methods and Considerations in Clinical Application

High frequency oscillations (HFOs) is a brain activity observed in electroencephalography (EEG) in frequency ranges between 80–500 Hz. HFOs can be classified into ripples (80–200 Hz) and fast ripples (200–500 Hz) by their distinctive characteristics. Recent studies reported that both ripples and fast fipples can be regarded as a new biomarker of epileptogenesis and ictogenesis. Previous studies verified that HFOs are clinically important both in patients with mesial temporal lobe epilepsy and neocortical epilepsy. Also, in epilepsy surgery, patients with higher resection ratio of brain regions with HFOs showed better outcome than a group with lower resection ratio. For clinical application of HFOs, it is important to delineate HFOs accurately and discriminate them from artifacts. There have been technical improvements in detecting HFOs by developing various detection algorithms. Still, there is a difficult issue on discriminating clinically important HFOs among detected HFOs, where both quantitative and subjective approaches are suggested. This paper is a review on published HFO studies focused on clinical findings and detection techniques of HFOs as well as tips for clinical applications.

High interictal connectivity within the resection zone is associated with favorable post-surgical outcomes in focal epilepsy patients

Patients with drug-resistant focal epilepsy are often candidates for invasive surgical therapies. In these patients, it is necessary to accurately localize seizure generators to ensure seizure freedom following intervention. While intracranial electroencephalography (iEEG) is the gold standard for mapping networks for surgery, this approach requires inducing and recording seizures, which may cause patient morbidity. The goal of this study is to evaluate the utility of mapping interictal (non-seizure) iEEG networks to identify targets for surgical treatment. We analyze interictal iEEG recordings and neuroimaging from 27 focal epilepsy patients treated via surgical resection. We generate interictal functional networks by calculating pairwise correlation of iEEG signals across different frequency bands. Using image coregistration and segmentation, we identify electrodes falling within surgically resected tissue (i.e. the resection zone), and compute node-level and edge-level synchrony in relation to the resection zone. We further associate these metrics with post-surgical outcomes. Greater overlap between resected electrodes and highly synchronous electrodes is associated with favorable post-surgical outcomes. Additionally, good-outcome patients have significantly higher connectivity localized within the resection zone compared to those with poorer postoperative seizure control. This finding persists following normalization by a spatially-constrained null model. This study suggests that spatially-informed interictal network synchrony measures can distinguish between good and poor post-surgical outcomes. By capturing clinically-relevant information during interictal periods, our method may ultimately reduce the need for prolonged invasive implants and provide insights into the pathophysiology of an epileptic brain. We discuss next steps for translating these findings into a prospectively useful clinical tool.

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We analyze interictal iEEG recordings and neuroimaging from epilepsy patients

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We find that high interictal strength selectivity is associated with better outcomes

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This effect appears to be driven largely by connectivity within the resection zone

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Interictal recordings can guide identification of seizure-generating networks

The neural tides of sleep and consciousness revealed by single-pulse electrical brain stimulation

Wakefulness and sleep arise from global changes in brain physiology that may also govern the flow of neural activity between cortical regions responsible for perceptual processing versus planning and action. To test whether and how the sleep/wake cycle affects the overall propagation of neural activity in large-scale brain networks, we applied single-pulse electrical stimulation (SPES) in patients implanted with intracranial EEG electrodes for epilepsy surgery. SPES elicited cortico-cortical spectral responses at high-gamma frequencies (CCSRHG, 80-150 Hz), which indexes changes in neuronal population firing rates. Using event-related causality (ERC) analysis, we found that the overall patterns of neural propagation among sites with CCSRHG were different during wakefulness and different sleep stages. For example, stimulation of frontal lobe elicited greater propagation toward parietal lobe during slow-wave sleep than during wakefulness. During REM sleep, we observed a decrease in propagation within frontal lobe, and an increase in propagation within parietal lobe, elicited by frontal and parietal stimulation, respectively. These biases in the directionality of large-scale cortical network dynamics during REM sleep could potentially account for some of the unique experiential aspects of this sleep stage. Together these findings suggest that the regulation of conscious awareness and sleep is associated with differences in the balance of neural propagation across large-scale frontal-parietal networks.

Prediction of epilepsy seizure from multi-channel electroencephalogram by effective connectivity analysis using Granger causality and directed transfer function methods

Epilepsy is a chronic disorder, which causes strange perceptions, muscle spasms, sometimes seizures, and loss of awareness, associated with abnormal neuronal activity in the brain. The goal of this study is to investigate how effective connectivity (EC) changes effect on unexpected seizures prediction, as this will authorize the patients to play it safe and avoid risk. We approve the hypothesis that EC variables near seizure change significantly so seizure can be predicted in accordance with this variation. We introduce two time-variant coefficients based on standard deviation of EC on Freiburg EEG dataset by using directed transfer function and Granger causality methods and compare index changes over the course of time in five different frequency bands. Comparison of the multivariate and bivariate analysis of factors is implemented in this investigation. The performance based on the suggested methods shows the seizure occurrence period is approximately 50 min that is expected onset stated in, the maximum value of sensitivity approaching ~ 80%, and 0.33 FP/h is the false prediction rate. The findings revealed that greater accuracy and sensitivity are obtained by the designed system in comparison with the results of other works in the same condition. Even though these results still are not sufficient for clinical applications. Based on the conclusions, it can generally be observed that the greater results by DTF method are in the gamma and beta frequency bands.

High-Frequency Oscillation Networks and Surgical Outcome in Adult Focal Epilepsy

OBJECTIVE

To investigate whether high-frequency oscillations (HFOs) show spatiotemporal propagation and assess the relevance of the earliest oscillations in relation to the seizure onset zone (SOZ) and postsurgical outcome.

METHODS

We retrospectively investigated the intracerebral electroencephalography (EEG) of patients who became seizure free after subsequent surgery. We marked HFOs during 1 hour of recordings. We calculated the time delay between pairs of channels as the median delay between their HFOs and constructed a time line of the delay of each channel with respect to the earliest channel (first source channel). A network was defined when a temporal order could be established among the channels based on the existence of statistically significant delays.

RESULTS

Fifteen patients with good surgical outcome were included. We found ripple networks in all patients, and fast ripple networks in 9. For ripples, first source channels were found in a higher proportion in the SOZ than the rest of the network channels (15 of 27 [56%] versus 93 of 262 [35%]; p = 0.04). For both ripples and fast ripples, first source channels were resected more often that the rest of the network channels (ripples: 13 of 27 [48%] versus 65 of 262 [25%]; p = 0.01; fast ripples: 8 of 9 [89%] versus 17 of 40 [43%]; p = 0.002); channels with the highest rates of ripples and fast ripples were resected in a similar proportion.

INTERPRETATION

These results demonstrate that interictal HFOs are organized in networks and indicate a possible need for the resection of first source channels. However, resecting them is not superior to resecting channels with highest rates of HFOs. Ann Neurol 2019;85:485-494.

Inferring directed networks using a rank-based connectivity measure

Inferring the topology of a network using the knowledge of the signals of each of the interacting units is key to understanding real-world systems. One way to address this problem is using data-driven methods like cross-correlation or mutual information. However, these measures lack the ability to distinguish the direction of coupling. Here, we use a rank-based nonlinear interdependence measure originally developed for pairs of signals. This measure not only allows one to measure the strength but also the direction of the coupling. Our results for a system of coupled Lorenz dynamics show that we are able to consistently infer the underlying network for a subrange of the coupling strength and link density. Furthermore, we report that the addition of dynamical noise can benefit the reconstruction. Finally, we show an application to multichannel electroencephalographic recordings from an epilepsy patient.

Interictal spike connectivity in human epileptic neocortex

OBJECTIVE

Interictal spikes are a biomarker of epilepsy, yet their precise roles are poorly understood. Using long-term neocortical recordings from epileptic patients, we investigated the spatial-temporal propagation patterns of interictal spiking.

METHODS

Interictal spikes were detected in 10 epileptic patients. Short time direct directed transfer function was used to map the spatial-temporal patterns of interictal spike onset and propagation across different cortical topographies.

RESULTS

Each patient had unique interictal spike propagation pattern that was highly consistent across times, regardless of the frequency band. High spiking brain regions were often not spike onset regions. We observed frequent spike propagations to shorter distances and that the central sulcus forms a strong barrier to spike propagation. Spike onset and seizure onset seemed to be distinct networks in most cases.

CONCLUSIONS

Patients in epilepsy have distinct and unique network of causal propagation pattern which are very consistent revealing the underlying epileptic network. Although spike are epileptic biomarkers, spike origin and seizure onset seems to be distinct in most cases.

SIGNIFICANCE

Understanding patterns of interictal spike propagation could lead to the identification patient-specific epileptic networks amenable to surgical or other treatments.

Phase-amplitude coupling between interictal high-frequency activity and slow waves in epilepsy surgery

OBJECTIVE

We hypothesized that the modulation index (MI), a summary measure of the strength of phase-amplitude coupling between high-frequency activity (>150 Hz) and the phase of slow waves (3-4 Hz), would serve as a useful interictal biomarker for epilepsy presurgical evaluation.

METHODS

We investigated 123 patients who underwent focal cortical resection following extraoperative electrocorticography recording and had at least 1 year of postoperative follow-up. We examined whether consideration of MI would improve the prediction of postoperative seizure outcome. MI was measured at each intracranial electrode site during interictal slow-wave sleep. We compared the accuracy of prediction of patients achieving International League Against Epilepsy class 1 outcome between the full multivariate logistic regression model incorporating MI in addition to conventional clinical, seizure onset zone (SOZ), and neuroimaging variables, and the reduced logistic regression model incorporating all variables other than MI.

RESULTS

Ninety patients had class 1 outcome at the time of most recent follow-up (mean follow-up = 5.7 years). The full model had a noteworthy outcome predictive ability, as reflected by regression model fit R² of 0.409 and area under the curve (AUC) of receiver operating characteristic plot of 0.838. Incomplete resection of SOZ (P < 0.001), larger number of antiepileptic drugs at the time of surgery (P = 0.007), and larger MI in nonresected tissues relative to that in resected tissue (P = 0.020) were independently associated with a reduced probability of class 1 outcome. The reduced model had a lower predictive ability as reflected by R² of 0.266 and AUC of 0.767. Anatomical variability in MI existed among nonepileptic electrode sites, defined as those unaffected by magnetic resonance imaging lesion, SOZ, or interictal spike discharges. With MI adjusted for anatomical variability, the full model yielded the outcome predictive ability of R² of 0.422, AUC of 0.844, and sensitivity/specificity of 0.86/0.76.

SIGNIFICANCE

MI during interictal recording may provide useful information for the prediction of postoperative seizure outcome.

Using network analysis to localize the epileptogenic zone from invasive EEG recordings in intractable focal epilepsy

Treatment of medically intractable focal epilepsy (MIFE) by surgical resection of the epileptogenic zone (EZ) is often effective provided the EZ can be reliably identified. Even with the use of invasive recordings, the clinical differentiation between the EZ and normal brain areas can be quite challenging, mainly in patients without MRI detectable lesions. Consequently, despite relatively large brain regions being removed, surgical success rates barely reach 60–65%. Such variable and unfavorable outcomes associated with high morbidity rates are often caused by imprecise and/or inaccurate EZ localization. We developed a localization algorithm that uses network-based data analytics to process invasive EEG recordings. This network algorithm analyzes the centrality signatures of every contact electrode within the recording network and characterizes contacts into susceptible EZ based on the centrality trends over time. The algorithm was tested in a retrospective study that included 42 patients from four epilepsy centers. Our algorithm had higher agreement with EZ regions identified by clinicians for patients with successful surgical outcomes and less agreement for patients with failed outcomes. These findings suggest that network analytics and a network systems perspective of epilepsy may be useful in assisting clinicians in more accurately localizing the EZ.

Epilepsy is a disease that results in abnormal firing patterns in parts of the brain that comprise the epileptogenic network, known as the epileptogenic zone (EZ). Current methods to localize the EZ for surgical treatment often require observations of hundreds of thousands of EEG data points measured from many electrodes implanted in a patient’s brain. In this paper, we used network science to show that EZ regions may exhibit specific network signatures before, during, and after seizure events. Our algorithm computes the likelihood of each electrode being in the EZ and tends to agree more with clinicians during successful resections and less during failed surgeries. These results suggest that a networked analysis approach to EZ localization may be valuable in a clinical setting.

Localization of Epileptogenic Zone With the Correction of Pathological Networks

Patients with focal drug-resistant epilepsy are potential candidates for surgery. Stereo-electroencephalograph (SEEG) is often considered as the “gold standard” to identify the epileptogenic zone (EZ) that accounts for the onset and propagation of epileptiform discharges. However, visual analysis of SEEG still prevails in clinical practice. In addition, epilepsy is increasingly understood to be the result of network disorder, but the specific organization of the epileptic network is still unclear. Therefore, it is necessary to quantitatively localize the EZ and investigate the nature of epileptogenic networks. In this study, intracranial recordings from 10 patients were analyzed through adaptive directed transfer function, and the out-degree of effective network was selected as the principal indicator to localize the epileptogenic area. Furthermore, a coupled neuronal population model was used to qualitatively simulate electrical activity in the brain. By removing individual populations, virtual surgery adjusting the network organization could be performed. Results suggested that the accuracy and detection rate of the EZ localization were 82.86 and 85.29%, respectively. In addition, the same stage shared a relatively stable connectivity pattern, while the patterns changed with transition to different processes. Meanwhile, eight cases of simulations indicated that networks in the ictal stage were more likely to generate rhythmic spikes. This indicated the existence of epileptogenic networks, which could enhance local excitability and facilitate synchronization. The removal of the EZ could correct these pathological networks and reduce the amount of spikes by at least 75%. This might be one reason why accurate resection could reduce or even suppress seizures. This study provides novel insights into epilepsy and surgical treatments from the network perspective.

The influence of filtering and downsampling on the estimation of transfer entropy

Transfer entropy (TE) provides a generalized and model-free framework to study Wiener-Granger causality between brain regions. Because of its nonparametric character, TE can infer directed information flow also from nonlinear systems. Despite its increasing number of applications in neuroscience, not much is known regarding the influence of common electrophysiological preprocessing on its estimation. We test the influence of filtering and downsampling on a recently proposed nearest neighborhood based TE estimator. Different filter settings and downsampling factors were tested in a simulation framework using a model with a linear coupling function and two nonlinear models with sigmoid and logistic coupling functions. For nonlinear coupling and progressively lower low-pass filter cut-off frequencies up to 72% false negative direct connections and up to 26% false positive connections were identified. In contrast, for the linear model, a monotonic increase was only observed for missed indirect connections (up to 86%). High-pass filtering (1 Hz, 2 Hz) had no impact on TE estimation. After low-pass filtering interaction delays were significantly underestimated. Downsampling the data by a factor greater than the assumed interaction delay erased most of the transmitted information and thus led to a very high percentage (67–100%) of false negative direct connections. Low-pass filtering increases the number of missed connections depending on the filters cut-off frequency. Downsampling should only be done if the sampling factor is smaller than the smallest assumed interaction delay of the analyzed network.

Functional Clustering approach for the analysis of Stereo-EEG activity patterns in correspondence of epileptic seizures

In this study, a functional clustering approach is proposed and tested for the identification of brain functional networks emerging during sleep-related seizures. Stereo-EEG signals recorded in patients with Type II Focal Cortical Dysplasia (FCD type II), were analyzed. This novel approach is able to identify the network configuration changes in pre-ictal and early ictal periods, by grouping Stereo-EEG signals on the basis of the Cluster Index, after wavelet multiscale decomposition. Results showed that the proposed method is able to detect clusters of interacting leads, mainly overlapped on the Epileptogenic Zone (EZ) identified by a clinical expert, with distinctive configurations related to analyzed frequency ranges. This suggested the presence of coupling activities between the elements of the epileptic system at different frequency scales.

Altered Effective Connectivity Network in Childhood Absence Epilepsy: A Multi-frequency MEG Study

Using multi-frequency magnetoencephalography (MEG) data, we investigated whether the effective connectivity (EC) network of patients with childhood absence epilepsy (CAE) is altered during the inter-ictal period in comparison with healthy controls. MEG data from 13 untreated CAE patients and 10 healthy controls were recorded. Correlation analysis and Granger causality analysis were used to construct an EC network at the source level in eight frequency bands. Alterations in the spatial pattern and topology of the network in CAE were investigated by comparing the patients with the controls. The network pattern was altered mainly in 1-4 Hz, showing strong connections within the frontal cortex and weak connections in the anterior-posterior pathways. The EC involving the precuneus/posterior cingulate cortex (PC/PCC) significantly decreased in low-frequency bands. In addition, the parameters of graph theory were significantly altered in several low- and high-frequency bands. CAE patients display frequency-specific abnormalities in the network pattern even during the inter-ictal period, and the frontal cortex and PC/PCC might play crucial roles in the pathophysiology of CAE. The EC network of CAE patients was over-connective and random during the inter-ictal period. This study is the first to reveal the frequency-specific alteration in the EC network during the inter-ictal period in CAE patients. Multiple-frequency MEG data are useful in investigating the pathophysiology of CAE, which can serve as new biomarkers of this disorder.

Estimation of resting state effective connectivity in epilepsy using direct-directed transfer function

There has been an increasing demand among neuroscientists to understand the complex network of functionally connected neural assemblies in the human brain. For this purpose, computational EEG research is widely used by researchers due to its remarkable advantage in providing high temporal resolution, and ease of analysis across different frequency bands. Here we analyzed Electrocorticographic (ECoG) signals of electrodes placed on frontal-parietal neocortex brain region of 8 pediatric epileptic patients. In order to evaluate the directed causal relationship among different brain regions, we employed a Granger causality based multivariate connectivity estimator named direct Directed Transfer Function (dDTF) to identify signal propagations among the selected set of electrode in the frequency range 1-50Hz. A consistent network pattern emerged that was unique to each patient. The fidelity of such dDTF-derived connectivity patterns can support a clearer understanding of effective connectivity in epileptic networks.