Prospective observational study: Fast ripple localization delineates the epileptogenic zone |
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| Institution: | 1. Division of Pediatric Neurology, Department of Pediatrics, UCLA Mattel Children’s Hospital, David Geffen School of Medicine, Los Angeles, CA, USA;2. Department of Neurosurgery, UCLA Medical Center, David Geffen School of Medicine, Los Angeles, CA, USA;3. Division of Neuroradiology, Department of Radiology, UCLA Medical Center, David Geffen School of Medicine, Los Angeles, CA, USA;4. Department of Medicine, Statistics Core, University of California, Los Angeles, CA, USA;1. Epilepsy Unit - Neurology Dept. Hospital del Mar - Parc de Salut Mar, Barcelona, Spain;2. IMIM - Hospital del Mar Medical Research Institute, Barcelona, Spain;3. Neurosurgery Unit -Hospital del Mar - Parc de Salut Mar, Barcelona, Spain;1. Surgical Neurology Branch, NINDS, National Institutes of Health, Bethesda, MD 20892, United States;2. Clinical Epilepsy Section, NINDS, National Institutes of Health, Bethesda, MD 20892, United States;3. Epilepsy Service and EEG Section, NINDS, National Institutes of Health, Bethesda, MD 20892, United States;1. Department of Pediatrics, Gyeongsang National University Hospital, Jinju, South Korea;2. Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, South Korea;3. Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, United States;4. Children’s Hospital & Medical Center, University of Nebraska, Omaha, NE, United States;1. Montreal Neurological Institute, McGill University, Montréal, Québec, Canada;2. École De Technologie Supérieure, Département de Génie Électrique, Montréal, Québec, Canada;3. Centre de Recherches Mathématiques, Montréal, Québec, Canada;4. NEUROFARBA Department, University of Florence, Italy;1. Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada;2. Pediatric Neurology Unit, Children''s Hospital A. Meyer, University of Florence, Florence, Italy;1. Department of Neuropediatrics and Muscular Diseases, University Medical Center Freiburg, Germany;2. Montreal Neurological Institute, McGill University, Canada;3. Department of Child Neurology, Okayama University Hospital, Kita-ku, Okayama, Japan;4. Medical Physics, University Medical Center Freiburg, Germany |
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| Abstract: | ObjectiveTo investigate spatial correlation between interictal HFOs and neuroimaging abnormalities, and to determine if complete removal of prospectively identified interictal HFOs correlates with post-surgical seizure-freedom.MethodsInterictal fast ripples (FRs: 250–500 Hz) in 19 consecutive children with pharmacoresistant focal epilepsy who underwent extra-operative electrocorticography (ECoG) recording were prospectively analyzed. The interictal FRs were sampled at 2000 Hz and were visually identified during 10 min of slow wave sleep. Interictal FRs, MRI and FDG-PET were delineated on patient-specific reconstructed three-dimensional brain MRI.ResultsInterictal FRs were observed in all patients except one. Thirteen out of 18 patients (72%) exhibited FRs beyond the extent of neuroimaging abnormalities. Fifteen of 19 children underwent resective surgery, and survival analysis with log-rank test demonstrated that complete resection of cortical sites showing interictal FRs correlated with longer post-operative seizure-freedom (p < 0.01). Complete resection of seizure onset zones (SOZ) also correlated with longer post-operative seizure-freedom (p = 0.01), yet complete resection of neuroimaging abnormalities did not (p = 0.43).ConclusionsProspective visual analysis of interictal FRs was feasible, and it seemed to accurately localize epileptogenic zones.SignificanceTopological extent of epileptogenic region may exceed what is discernible by multimodal neuroimaging. |
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| Keywords: | Epilepsy surgery High frequency oscillations HFO FR Ripple |
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