Association of fast ripples on intracranial EEG and outcomes after epilepsy surgery.

Autor:	Nevalainen P; From the Montreal Neurological Institute and Hospital (P.N., N.v.E., P.K., F.D., B.F., J.G.), McGill University, Quebec, Canada; and Department of Clinical Neurophysiology (P.N.), Children´s Hospital, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Finland. paivi.nevalainen@hus.fi., von Ellenrieder N; From the Montreal Neurological Institute and Hospital (P.N., N.v.E., P.K., F.D., B.F., J.G.), McGill University, Quebec, Canada; and Department of Clinical Neurophysiology (P.N.), Children´s Hospital, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Finland., Klimeš P; From the Montreal Neurological Institute and Hospital (P.N., N.v.E., P.K., F.D., B.F., J.G.), McGill University, Quebec, Canada; and Department of Clinical Neurophysiology (P.N.), Children´s Hospital, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Finland., Dubeau F; From the Montreal Neurological Institute and Hospital (P.N., N.v.E., P.K., F.D., B.F., J.G.), McGill University, Quebec, Canada; and Department of Clinical Neurophysiology (P.N.), Children´s Hospital, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Finland., Frauscher B; From the Montreal Neurological Institute and Hospital (P.N., N.v.E., P.K., F.D., B.F., J.G.), McGill University, Quebec, Canada; and Department of Clinical Neurophysiology (P.N.), Children´s Hospital, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Finland., Gotman J; From the Montreal Neurological Institute and Hospital (P.N., N.v.E., P.K., F.D., B.F., J.G.), McGill University, Quebec, Canada; and Department of Clinical Neurophysiology (P.N.), Children´s Hospital, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Finland.
Jazyk:	angličtina
Zdroj:	Neurology [Neurology] 2020 Oct 20; Vol. 95 (16), pp. e2235-e2245. Date of Electronic Publication: 2020 Aug 04.
DOI:	10.1212/WNL.0000000000010468
Abstrakt:	Objective: To examine whether fast ripples (FRs) are an accurate marker of the epileptogenic zone, we analyzed overnight stereo-EEG recordings from 43 patients and hypothesized that FR resection ratio, maximal FR rate, and FR distribution predict postsurgical seizure outcome. Methods: We detected FRs automatically from an overnight recording edited for artifacts and visually from a 5-minute period of slow-wave sleep. We examined primarily the accuracy of removing ≥50% of total FR events or of channels with FRs to predict postsurgical seizure outcome (Engel class I = good, classes II-IV = poor) according to the whole-night and 5-minute analysis approaches. Secondarily, we examined the association of low overall FR rates or absence or incomplete resection of 1 dominant FR area with poor outcome. Results: The accuracy of outcome prediction was highest (81%, 95% confidence interval [CI] 67%-92%) with the use of the FR event resection ratio and whole-night recording (vs 72%, 95% CI 56%-85%, for the visual 5-minute approach). Absence of channels with FR rates >6/min ( p = 0.001) and absence or incomplete resection of 1 dominant FR area ( p < 0.001) were associated with poor outcome. Conclusions: FRs are accurate in predicting epilepsy surgery outcome at the individual level when overnight recordings are used. Absence of channels with high FR rates or absence of 1 dominant FR area is a poor prognostic factor that may reflect suboptimal spatial sampling of the epileptogenic zone or multifocality, rather than an inherently low sensitivity of FRs. Classification of Evidence: This study provides Class II evidence that FRs are accurate in predicting epilepsy surgery outcome. (© 2020 American Academy of Neurology.)
Databáze:	MEDLINE
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