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Lin J, Smith GC, Gliske SV, Zochowski M, Shedden K, Stacey WC. High frequency oscillation network dynamics predict outcome in non-palliative epilepsy surgery. Brain Commun 2024; 6:fcae032. [PMID: 38384998 PMCID: PMC10881100 DOI: 10.1093/braincomms/fcae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 12/28/2023] [Accepted: 02/05/2024] [Indexed: 02/23/2024] Open
Abstract
High frequency oscillations are a promising biomarker of outcome in intractable epilepsy. Prior high frequency oscillation work focused on counting high frequency oscillations on individual channels, and it is still unclear how to translate those results into clinical care. We show that high frequency oscillations arise as network discharges that have valuable properties as predictive biomarkers. Here, we develop a tool to predict patient outcome before surgical resection is performed, based on only prospective information. In addition to determining high frequency oscillation rate on every channel, we performed a correlational analysis to evaluate the functional connectivity of high frequency oscillations in 28 patients with intracranial electrodes. We found that high frequency oscillations were often not solitary events on a single channel, but part of a local network discharge. Eigenvector and outcloseness centrality were used to rank channel importance within the connectivity network, then used to compare patient outcome by comparison with the seizure onset zone or a proportion within the proposed resected channels (critical resection percentage). Combining the knowledge of each patient's seizure onset zone resection plan along with our computed high frequency oscillation network centralities and high frequency oscillation rate, we develop a Naïve Bayes model that predicts outcome (positive predictive value: 100%) better than predicting based upon fully resecting the seizure onset zone (positive predictive value: 71%). Surgical margins had a large effect on outcomes: non-palliative patients in whom most of the seizure onset zone was resected ('definitive surgery', ≥ 80% resected) had predictable outcomes, whereas palliative surgeries (<80% resected) were not predictable. These results suggest that the addition of network properties of high frequency oscillations is more accurate in predicting patient outcome than seizure onset zone alone in patients with most of the seizure onset zone removed and offer great promise for informing clinical decisions in surgery for refractory epilepsy.
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Affiliation(s)
- Jack Lin
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI 48109, USA
| | - Garnett C Smith
- Department of Pediatrics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Stephen V Gliske
- Department of Neurosurgery, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Michal Zochowski
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Physics and Biophysics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kerby Shedden
- Department of Statistics and Biostatistics, University of Michigan, Ann Arbor, MI 48109, USA
| | - William C Stacey
- Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Biomedical Engineering, BioInterfaces Institute, University of Michigan, Ann Arbor, MI 48109, USA
- Division of Neurology, Ann Arbor VA Health System, Ann Arbor, MI 48109, USA
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Revajová K, Trávníček V, Jurák P, Vašíčková Z, Halámek J, Klimeš P, Cimbálník J, Brázdil M, Pail M. Interictal invasive very high-frequency oscillations in resting awake state and sleep. Sci Rep 2023; 13:19225. [PMID: 37932365 PMCID: PMC10628183 DOI: 10.1038/s41598-023-46024-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/26/2023] [Indexed: 11/08/2023] Open
Abstract
Interictal very high-frequency oscillations (VHFOs, 500-2000 Hz) in a resting awake state seem to be, according to a precedent study of our team, a more specific predictor of a good outcome of the epilepsy surgery compared to traditional interictal high-frequency oscillations (HFOs, 80-500 Hz). In this study, we retested this hypothesis on a larger cohort of patients. In addition, we also collected patients' sleep data and hypothesized that the occurrence of VHFOs in sleep will be greater than in resting state. We recorded interictal invasive electroencephalographic (iEEG) oscillations in 104 patients with drug-resistant epilepsy in a resting state and in 35 patients during sleep. 21 patients in the rest study and 11 patients in the sleep study met the inclusion criteria (interictal HFOs and VHFOs present in iEEG recordings, a surgical intervention and a postoperative follow-up of at least 1 year) for further evaluation of iEEG data. In the rest study, patients with good postoperative outcomes had significantly higher ratio of resected contacts with VHFOs compared to HFOs. In sleep, VHFOs were more abundant than in rest and the percentage of resected contacts in patients with good and poor outcomes did not considerably differ in any type of oscillations. In conclusion, (1) our results confirm, in a larger patient cohort, our previous work about VHFOs being a specific predictor of the area which needs to be resected; and (2) that more frequent sleep VHFOs do not further improve the results.
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Affiliation(s)
- Karin Revajová
- Brno Epilepsy Center, Department of Neurology, member of ERN-EpiCARE, St Anne's University Hospital and Medical Faculty of Masaryk University, Brno, 602 00, Czech Republic.
| | - Vojtěch Trávníček
- Institute of Scientific Instruments, Czech Academy of Sciences, Brno, 602 00, Czech Republic
- International Clinical Research Center, St Anne's University Hospital, Brno, 602 00, Czech Republic
| | - Pavel Jurák
- Institute of Scientific Instruments, Czech Academy of Sciences, Brno, 602 00, Czech Republic
| | - Zuzana Vašíčková
- Brno Epilepsy Center, Department of Neurology, member of ERN-EpiCARE, St Anne's University Hospital and Medical Faculty of Masaryk University, Brno, 602 00, Czech Republic
- Institute of Scientific Instruments, Czech Academy of Sciences, Brno, 602 00, Czech Republic
- International Clinical Research Center, St Anne's University Hospital, Brno, 602 00, Czech Republic
| | - Josef Halámek
- Institute of Scientific Instruments, Czech Academy of Sciences, Brno, 602 00, Czech Republic
| | - Petr Klimeš
- Institute of Scientific Instruments, Czech Academy of Sciences, Brno, 602 00, Czech Republic
- International Clinical Research Center, St Anne's University Hospital, Brno, 602 00, Czech Republic
| | - Jan Cimbálník
- Brno Epilepsy Center, Department of Neurology, member of ERN-EpiCARE, St Anne's University Hospital and Medical Faculty of Masaryk University, Brno, 602 00, Czech Republic
- International Clinical Research Center, St Anne's University Hospital, Brno, 602 00, Czech Republic
| | - Milan Brázdil
- Brno Epilepsy Center, Department of Neurology, member of ERN-EpiCARE, St Anne's University Hospital and Medical Faculty of Masaryk University, Brno, 602 00, Czech Republic
- Central European Institute of Technology, Masaryk University, Brno, 602 00, Czech Republic
- International Clinical Research Center, St Anne's University Hospital, Brno, 602 00, Czech Republic
| | - Martin Pail
- Brno Epilepsy Center, Department of Neurology, member of ERN-EpiCARE, St Anne's University Hospital and Medical Faculty of Masaryk University, Brno, 602 00, Czech Republic
- International Clinical Research Center, St Anne's University Hospital, Brno, 602 00, Czech Republic
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