In drug-resistant focal epilepsy, planning surgical resection may involve presurgical intracranial EEG recordings (iEEG) to detect seizures and other iEEG patterns to improve postsurgical seizure outcome. We hypothesized that resection of tissue generating interictal high frequency oscillations (HFOs, 80-500 Hz) in the iEEG predicts surgical outcome. Eight international epilepsy centres recorded iEEG during the patients’ pre-surgical evaluation. The patients were of all ages, had epilepsy of all types, and underwent surgical resection of a single focus aiming at seizure freedom. In a prospective analysis we applied a fully automated definition of HFO which was independent of the dataset. Using an observational cohort design that was blinded to postsurgical seizure outcome, we analysed HFO rates during non-rapid-eye-movement sleep. If channels had consistently high rates over multiple epochs, they were labelled the “HFO area”. After HFO analysis, centres provided the electrode contacts located in the resected volume and the seizure outcome at follow-up ≥24 months after surgery. The study was registered at www.clinicaltrials.gov (NCT05332990). We received 160 iEEG datasets. In 146 datasets (91%), the HFO area could be defined. The patients with completely resected HFO area were more likely to achieve seizure freedom compared to those without (OR 2.61 CI [1.15-5.91], P = 0.02). Among seizure free patients, the HFO area was completely resected in 31 and was not completely resected in 43. Among patients with recurrent seizures, the HFO area was completely resected in 14 and was not completely resected in 58. When predicting seizure freedom, the negative predictive value of the HFO area (68% CI [52-81]) was higher than that for the resected volume as predictor by itself (51% CI [42-59], P = 4e-5). The sensitivity and specificity for complete HFO area resection were 0.88 CI [0.72-0.98] and 0.39 CI [0.25-0.54] and the area under the curve was 0.83 CI [0.58-0.97], indicating good predictive performance. In a blinded cohort study from independent epilepsy centres, applying a previously validated algorithm for HFO marking without the need of adjusting to new datasets allowed us to validate the clinical relevance of HFOs to plan the surgical resection.

中文翻译：

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通过去除高频振荡预测的癫痫发作结局的多中心分析


在耐药性局灶性癫痫中，计划手术切除可能涉及术前颅内脑电图记录 （iEEG） 以检测癫痫发作和其他 iEEG 模式以改善术后癫痫发作结局。我们假设切除在 iEEG 中产生发作间高频振荡 （HFO， 80-500 Hz） 的组织可预测手术结果。8 个国际癫痫中心在患者术前评估期间记录了 iEEG。患者年龄不一，患有各种类型的癫痫，并接受了旨在无癫痫发作的单病灶手术切除。在前瞻性分析中，我们应用了独立于数据集的 HFO 的全自动定义。使用对术后癫痫发作结局不知情的观察性队列设计，我们分析了非快速眼动睡眠期间的 HFO 发生率。如果通道在多个 epoch 中始终保持高速率，则它们被标记为“HFO 区域”。HFO 分析后，中心提供了位于切除体积中的电极触点和术后随访 ≥24 个月）的癫痫发作结果。该研究于 www.clinicaltrials.gov （NCT05332990） 注册。我们收到了 160 个 iEEG 数据集。在 146 个数据集 （91%） 中，可以定义 HFO 区域。与未切除HFO区域的患者相比，HFO区域完全切除的患者更有可能实现无癫痫发作（OR 2.61CI [1.15-5.91]，P=0.02）。在无癫痫发作的患者中，31 例 HFO 区域被完全切除，43 例未完全切除。在反复发作的患者中，14 例 HFO 区域被完全切除，58 例未完全切除。 在预测无癫痫发作时，HFO面积的阴性预测值（68% CI [52-81]）高于作为预测因子的切除体积的阴性预测值（51% CI [42-59]，P=4e-5）。HFO区域完全切除术的敏感性和特异性分别为0.88 CI [0.72-0.98]和0.39 CI [0.25-0.54]，曲线下面积为0.83 CI [0.58-0.97]，表明预测性能良好。在来自独立癫痫中心的一项盲法队列研究中，应用先前验证的 HFO 标记算法而无需调整新的数据集，使我们能够验证 HFO 与计划手术切除的临床相关性。