Authors :
Presenting Author: Hiroshi Uda, MD, PhD – Wayne State University
Naoto Kuroda, MD, PhD – Wayne State University
Keisuke Hatano, MD, PhD – Wayne State University
Ethan Firestone, MS – Wayne State University
Ryuzaburo Kochi, MD, PhD – Wayne State University
Ece Erder, MS – Wayne State University
Dominik Choromanski, MD – Children’s Hospital of Michigan
Michael Cools, MD – Children's Hospital of Michigan
Aimee Luat, MD – Children’s Hospital of Michigan
Eishi Asano, MD, PhD – Wayne State University
Rationale:
We aimed to assess whether resection of regions generating frequent high-frequency oscillations (HFOs) on intraoperative recording is associated with postoperative seizure control in children with drug-resistant, MRI-negative focal epilepsy.Methods:
We studied 42 children (aged 0.7–20 years; 19 girls) who underwent intraoperative electrocorticography (ECoG) during intracranial electrode placement, followed by extraoperative intracranial EEG (iEEG) and curative focal resection. Using an open-source detector, we computed the rate of HFOs ≥80 Hz from five-minute intraoperative iEEG segments recorded under isoflurane anesthesia. Frequent HFO sites were defined as regions with HFO rates exceeding the 95th percentile within each patient. We constructed three multivariate logistic regression models: [1] HFO model, which included whether frequent HFO sites were completely resected; [2] Seizure onset zone (SOZ) model, which included whether SOZ sites, defined by extraoperative iEEG, were completely resected; [3] Combined HFO & SOZ model, which included whether both frequent HFO sites and SOZ sites were completely resected. All models also included the following covariates: (i) age, (ii) sex, and (iii) whether habitual seizures were captured during extraoperative iEEG monitoring. Model performance for classifying patients with an ILAE class 1 outcome at ≥1-year follow-up was evaluated using the area under the receiver operating characteristic curve (AUC).Results:
ILAE class 1 outcomes were achieved in 19 patients (45%). The HFO model classified patients with ILAE class 1 outcomes with an AUC of 0.70 (95% confidence interval [CI]: 0.54–0.86). The SOZ model yielded an AUC of 0.73 (95% CI: 0.58–0.88), and the combined HFO & SOZ model yielded an AUC of 0.75 (95% CI: 0.59–0.90).Conclusions:
Intraoperatively recorded HFOs may provide complementary diagnostic value for presurgical evaluation in MRI-negative focal epilepsy.Funding:
JSPS Overseas Research Fellowships, 202560628 (to H.U.), NIH NS064033 (to E.A.).