Noninvasive high-frequency oscillations riding spikes delineates epileptogenic sources.
Noninvasive high-frequency oscillations riding spikes delineates epileptogenic sources.
复制标题
无创性高频振荡骑棘波划定癫痫源。
DOI：
10.1073/pnas.2011130118
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发表时间：
2021-04-27
影响因子：
11.1
通讯作者：
He B
中科院分区：
文献类型：
--
作者：
Cai Z;Sohrabpour A;Jiang H;Ye S;Joseph B;Brinkmann BH;Worrell GA;He B
如果能够准确地勾画出这样的癫痫灶，数百万癫痫患者可能会接受癫痫组织的手术切除，以阻止癫痫发作。高频振荡(HFO)存在于脑电活动中，与癫痫脑功能高度相关，有望指导成功的神经外科手术。然而，由于存在各种非癫痫高频活动，目前尚不清楚是否以及如何区分病理性HFO以定位致痫组织。在这里，我们展示了形态和来源的影像证据，病理性的HFO可以通过癫痫样棘波的共存来识别。我们描述了一个框架，以描绘潜在的致痫作用使用这个生物标记物。我们的工作可能会提供翻译工具，通过非侵入性地描述病理活动从而改善癫痫灶的治疗。高频振荡(HFO)是一种很有前景的生物标志物，可用于癫痫脑的定位和指导成功的神经外科手术。然而，尽管非侵入性高频电信号的使用和翻译是非常可取的，但由于难以区分病理性高频电信号和非癫痫样高频活动，以及使用通常被高噪声污染的非侵入性头皮记录来定位癫痫组织，这一点阻碍了非侵入性高频电信号的使用和翻译。在这里，我们表明，HFO与癫痫样棘波(PHFO)的一致共存为自动识别病理性HFO提供了一种易于处理的手段，这反过来又在25例颞叶癫痫患者(包括总共2967个发作间期棘波和1,477个HFO事件)中标记出与癫痫相关性更高的癫痫样棘波亚群。我们发现，在存在/不存在这种并发状态的情况下，HFO和棘波的形态存在显著差异。我们还证明，与传统的棘波成像相比，建议的PHFO源成像对致痫组织的定位与手术切除的符合率提高了162%(∼5.36 mm)，与侵入性研究确定的癫痫发作起始区的符合率(∼12.48 mm)提高了186%，并与手术结果显示了更好的一致性。值得注意的是，有PHFOS的棘波的存在选择性地提高了棘波成像的性能，特别是在有多种类型棘波的患者中。我们的发现表明，并发的HFO和棘波相互区分病理活动，为脆弱患者的无创性术前诊断和术后评估提供了一种翻译工具。
Millions of people affected by epilepsy may undergo surgical resection of the epileptic tissues to stop seizures if such epileptic foci can be accurately delineated. High-frequency oscillations (HFOs), existing in electroencephalography, are highly correlated with epileptic brain, which is promising for guiding successful neurosurgery. However, it is unclear whether and how pathological HFOs can be differentiated to localize the epileptogenic tissues given the presence of various nonepileptic high-frequency activities. Here, we show morphological and source imaging evidence that pathological HFOs can be identified by the concurrence of epileptiform spikes. We describe a framework to delineate the underlying epileptogenicity using this biomarker. Our work may offer translational tools to improve treatments by noninvasively demarking pathological activities and hence epileptic foci. High-frequency oscillations (HFOs) are a promising biomarker for localizing epileptogenic brain and guiding successful neurosurgery. However, the utility and translation of noninvasive HFOs, although highly desirable, is impeded by the difficulty in differentiating pathological HFOs from nonepileptiform high-frequency activities and localizing the epileptic tissue using noninvasive scalp recordings, which are typically contaminated with high noise levels. Here, we show that the consistent concurrence of HFOs with epileptiform spikes (pHFOs) provides a tractable means to identify pathological HFOs automatically, and this in turn demarks an epileptiform spike subgroup with higher epileptic relevance than the other spikes in a cohort of 25 temporal epilepsy patients (including a total of 2,967 interictal spikes and 1,477 HFO events). We found significant morphological distinctions of HFOs and spikes in the presence/absence of this concurrent status. We also demonstrated that the proposed pHFO source imaging enhanced localization of epileptogenic tissue by 162% (∼5.36 mm) for concordance with surgical resection and by 186% (∼12.48 mm) with seizure-onset zone determined by invasive studies, compared to conventional spike imaging, and demonstrated superior congruence with the surgical outcomes. Strikingly, the performance of spike imaging was selectively boosted by the presence of spikes with pHFOs, especially in patients with multitype spikes. Our findings suggest that concurrent HFOs and spikes reciprocally discriminate pathological activities, providing a translational tool for noninvasive presurgical diagnosis and postsurgical evaluation in vulnerable patients.
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