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Wang Z, Guo J, van 't Klooster M, Hoogteijling S, Jacobs J, Zijlmans M. Prognostic Value of Complete Resection of the High-Frequency Oscillation Area in Intracranial EEG: A Systematic Review and Meta-Analysis. Neurology 2024; 102:e209216. [PMID: 38560817 PMCID: PMC11175645 DOI: 10.1212/wnl.0000000000209216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 01/12/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND AND OBJECTIVES High-frequency oscillations (HFOs; ripples 80-250 Hz; fast ripples [FRs] 250-500 Hz) recorded with intracranial electrodes generated excitement and debate about their potential to localize epileptogenic foci. We performed a systematic review and meta-analysis on the prognostic value of complete resection of the HFOs-area (crHFOs-area) for epilepsy surgical outcome in intracranial EEG (iEEG) accessing multiple subgroups. METHODS We searched PubMed, Embase, and Web of Science for original research from inception to October 27, 2022. We defined favorable surgical outcome (FSO) as Engel class I, International League Against Epilepsy class 1, or seizure-free status. The prognostic value of crHFOs-area for FSO was assessed by (1) the pooled FSO proportion after crHFOs-area; (2) FSO for crHFOs-area vs without crHFOs-area; and (3) the predictive performance. We defined high combined prognostic value as FSO proportion >80% + FSO crHFOs-area >without crHFOs-area + area under the curve (AUC) >0.75 and examined this for the clinical subgroups (study design, age, diagnostic type, HFOs-identification method, HFOs-rate thresholding, and iEEG state). Temporal lobe epilepsy (TLE) was compared with extra-TLE through dichotomous variable analysis. Individual patient analysis was performed for sex, affected hemisphere, MRI findings, surgery location, and pathology. RESULTS Of 1,387 studies screened, 31 studies (703 patients) met our eligibility criteria. Twenty-seven studies (602 patients) analyzed FRs and 20 studies (424 patients) ripples. Pooled FSO proportion after crHFOs-area was 81% (95% CI 76%-86%) for FRs and 82% (73%-89%) for ripples. Patients with crHFOs-area achieved more often FSO than those without crHFOs-area (FRs odds ratio [OR] 6.38, 4.03-10.09, p < 0.001; ripples 4.04, 2.32-7.04, p < 0.001). The pooled AUCs were 0.81 (0.77-0.84) for FRs and 0.76 (0.72-0.79) for ripples. Combined prognostic value was high in 10 subgroups: retrospective, children, long-term iEEG, threshold (FRs and ripples) and automated detection and interictal (FRs). FSO after complete resection of FRs-area (crFRs-area) was achieved less often in people with TLE than extra-TLE (OR 0.37, 0.15-0.89, p = 0.006). Individual patient analyses showed that crFRs-area was seen more in patients with FSO with than without MRI lesions (p = 0.02 after multiple correction). DISCUSSION Complete resection of the brain area with HFOs is associated with good postsurgical outcome. Its prognostic value holds, especially for FRs, for various subgroups. The use of HFOs for extra-TLE patients requires further evidence.
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Affiliation(s)
- Ziyi Wang
- From the Department of Neurology and Neurosurgery (Z.W., J.G., M.v.t.K., S.H., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE, the Netherlands; Department of Pediatrics (J.J.), University of Calgary, Alberta Children's Hospital, Calgary, Canada; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), Heemstede, the Netherlands
| | - Jiaojiao Guo
- From the Department of Neurology and Neurosurgery (Z.W., J.G., M.v.t.K., S.H., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE, the Netherlands; Department of Pediatrics (J.J.), University of Calgary, Alberta Children's Hospital, Calgary, Canada; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), Heemstede, the Netherlands
| | - Maryse van 't Klooster
- From the Department of Neurology and Neurosurgery (Z.W., J.G., M.v.t.K., S.H., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE, the Netherlands; Department of Pediatrics (J.J.), University of Calgary, Alberta Children's Hospital, Calgary, Canada; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), Heemstede, the Netherlands
| | - Sem Hoogteijling
- From the Department of Neurology and Neurosurgery (Z.W., J.G., M.v.t.K., S.H., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE, the Netherlands; Department of Pediatrics (J.J.), University of Calgary, Alberta Children's Hospital, Calgary, Canada; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), Heemstede, the Netherlands
| | - Julia Jacobs
- From the Department of Neurology and Neurosurgery (Z.W., J.G., M.v.t.K., S.H., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE, the Netherlands; Department of Pediatrics (J.J.), University of Calgary, Alberta Children's Hospital, Calgary, Canada; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), Heemstede, the Netherlands
| | - Maeike Zijlmans
- From the Department of Neurology and Neurosurgery (Z.W., J.G., M.v.t.K., S.H., M.Z.), University Medical Center Utrecht Brain Center, University Medical Center Utrecht, Part of ERN EpiCARE, the Netherlands; Department of Pediatrics (J.J.), University of Calgary, Alberta Children's Hospital, Calgary, Canada; and Stichting Epilepsie Instellingen Nederland (SEIN) (M.Z.), Heemstede, the Netherlands
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Frauscher B, Rossetti AO, Beniczky S. Recent advances in clinical electroencephalography. Curr Opin Neurol 2024; 37:134-140. [PMID: 38230652 DOI: 10.1097/wco.0000000000001246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
PURPOSE OF REVIEW Clinical electroencephalography (EEG) is a conservative medical field. This explains likely the significant gap between clinical practice and new research developments. This narrative review discusses possible causes of this discrepancy and how to circumvent them. More specifically, we summarize recent advances in three applications of clinical EEG: source imaging (ESI), high-frequency oscillations (HFOs) and EEG in critically ill patients. RECENT FINDINGS Recently published studies on ESI provide further evidence for the accuracy and clinical utility of this method in the multimodal presurgical evaluation of patients with drug-resistant focal epilepsy, and opened new possibilities for further improvement of the accuracy. HFOs have received much attention as a novel biomarker in epilepsy. However, recent studies questioned their clinical utility at the level of individual patients. We discuss the impediments, show up possible solutions and highlight the perspectives of future research in this field. EEG in the ICU has been one of the major driving forces in the development of clinical EEG. We review the achievements and the limitations in this field. SUMMARY This review will promote clinical implementation of recent advances in EEG, in the fields of ESI, HFOs and EEG in the intensive care.
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Affiliation(s)
- Birgit Frauscher
- Department of Neurology, Duke University Medical Center & Department of Biomedical Engineering, Duke Pratt School of Engineering, Durham, North Carolina, USA
| | - Andrea O Rossetti
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund
- Aarhus University Hospital, Aarhus, Denmark
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Freund BE, Sherman WJ, Sabsevitz DS, Middlebrooks EH, Feyissa AM, Garcia DM, Grewal SS, Chaichana KL, Quinones-Hinojosa A, Tatum WO. Can we improve electrocorticography using a circular grid array in brain tumor surgery? Biomed Phys Eng Express 2023; 9:065027. [PMID: 37871586 DOI: 10.1088/2057-1976/ad05dd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 10/23/2023] [Indexed: 10/25/2023]
Abstract
Intraoperative electrocorticography (iECoG) is used as an adjunct to localize the epileptogenic zone during surgical resection of brain tumors in patients with focal epilepsies. It also enables monitoring of after-discharges and seizures with EEG during functional brain mapping with electrical stimulation. When seizures or after-discharges are present, they complicate accurate interpretation of the mapping strategy to outline the brain's eloquent function and can affect the surgical procedure. Recurrent seizures during surgery requires urgent treatment and, when occurring during awake craniotomy, often leads to premature termination of brain mapping due to post-ictal confusion or sedation from acute rescue therapy. There are mixed results in studies on efficacy with iECoG in patients with epilepsy and brain tumors influencing survival and functional outcomes following surgery. Commercially available electrode arrays have inherent limitations. These could be improved with customization potentially leading to greater precision in safe and maximal resection of brain tumors. Few studies have assessed customized electrode grid designs as an alternative to commercially available products. Higher density electrode grids with intercontact distances less than 1 cm improve spatial delineation of electrophysiologic sources, including epileptiform activity, electrographic seizures, and afterdischarges on iECoG during functional brain mapping. In response to the shortcomings of current iECoG grid technologies, we designed and developed a novel higher-density hollow circular electrode grid array. The 360-degree iECoG monitoring capability allows continuous EEG recording during surgical intervention through the aperture with and without electrical stimulation mapping. Compared with linear strip electrodes that are commonly used for iECoG during surgery, the circular grid demonstrates significant benefits in brain tumor surgery. This includes quicker recovery of post-operative motor deficits (2.4 days versus 9 days, p = 0.05), more extensive tumor resection (92.0% versus 77.6%, p = 0.003), lesser reduction in Karnofsky Performance scale postoperatively (-2 versus -11.6, p = 0.007), and more sensitivity to recording afterdischarges. In this narrative review, we discuss the advantages and disadvantages of commercially available recording devices in the operating room and focus on the usefulness of the higher-density circular grid.
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Affiliation(s)
- Brin E Freund
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
| | - Wendy J Sherman
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
| | - David S Sabsevitz
- Department of Psychiatry, Division of Neuropsychology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
| | - Erik H Middlebrooks
- Department of Radiology, Division of Neuroradiology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
- Department of Neurosurgery, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
| | - Anteneh M Feyissa
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
| | - Diogo Moniz Garcia
- Department of Neurosurgery, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
| | - Sanjeet S Grewal
- Department of Neurosurgery, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
| | - Kaisorn L Chaichana
- Department of Neurosurgery, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
| | - Alfredo Quinones-Hinojosa
- Department of Neurosurgery, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
| | - William O Tatum
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, FL, United States of America
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Al-Bakri AF, Martinek R, Pelc M, Zygarlicki J, Kawala-Sterniuk A. Implementation of a Morphological Filter for Removing Spikes from the Epileptic Brain Signals to Improve Identification Ripples. SENSORS (BASEL, SWITZERLAND) 2022; 22:7522. [PMID: 36236621 PMCID: PMC9571066 DOI: 10.3390/s22197522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/20/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Epilepsy is a very common disease affecting at least 1% of the population, comprising a number of over 50 million people. As many patients suffer from the drug-resistant version, the number of potential treatment methods is very small. However, since not only the treatment of epilepsy, but also its proper diagnosis or observation of brain signals from recordings are important research areas, in this paper, we address this very problem by developing a reliable technique for removing spikes and sharp transients from the baseline of the brain signal using a morphological filter. This allows much more precise identification of the so-called epileptic zone, which can then be resected, which is one of the methods of epilepsy treatment. We used eight patients with 5 KHz data set and depended upon the Staba 2002 algorithm as a reference to detect the ripples. We found that the average sensitivity and false detection rate of our technique are significant, and they are ∼94% and ∼14%, respectively.
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Affiliation(s)
- Amir F. Al-Bakri
- Department of Biomedical Engineering, College of Engineering, University of Babylon, Hillah 51001, Iraq
| | - Radek Martinek
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, 45-758 Opole, Poland
- Department of Cybernetics and Biomedical Engineering, VSB-Technical University Ostrava—FEECS, 708 00 Ostrava–Poruba, Czech Republic
| | - Mariusz Pelc
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, 45-758 Opole, Poland
- School of Computing and Mathematical Sciences, University of Greenwich, Park Row, London SE10 9LS, UK
| | - Jarosław Zygarlicki
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, 45-758 Opole, Poland
| | - Aleksandra Kawala-Sterniuk
- Faculty of Electrical Engineering, Automatic Control and Informatics, Opole University of Technology, 45-758 Opole, Poland
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