Long-term satisfaction after extraoperative invasive EEG recording

Masaki Sonoda; Alanna Carlson; Robert Rothermel; Naoto Kuroda; Hirotaka Iwaki; Aimee F Luat; Sandeep Sood; Eishi Asano

doi:10.1016/j.yebeh.2021.108363

Long-term satisfaction after extraoperative invasive EEG recording

Epilepsy Behav. 2021 Oct 27:124:108363. doi: 10.1016/j.yebeh.2021.108363. Online ahead of print.

Authors

Masaki Sonoda¹, Alanna Carlson², Robert Rothermel³, Naoto Kuroda⁴, Hirotaka Iwaki⁴, Aimee F Luat⁵, Sandeep Sood⁶, Eishi Asano⁷

Affiliations

¹ Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA; Department of Neurosurgery, Yokohama City University, Yokohama, Kanagawa 2360004, Japan.
² Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA; Department of Psychiatry, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA.
³ Department of Psychiatry, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA.
⁴ Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA; Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai 9808575, Japan.
⁵ Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA; Department of Neurology, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA; Department of Pediatrics, Central Michigan University, Mount Pleasant, MI 48858, USA.
⁶ Department of Neurosurgery, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA.
⁷ Department of Pediatrics, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA; Department of Neurology, Children's Hospital of Michigan, Detroit Medical Center, Wayne State University, Detroit, MI 48201, USA. Electronic address: easano@med.wayne.edu.

Abstract

This retrospective cohort study investigated 53 patients with drug-resistant focal epilepsy and identified factors predictive of long-term satisfaction of patients and families following extraoperative intracranial EEG (iEEG) recording. The mixed model analysis assessed the utility of intracranial EEG (iEEG) predictor variables, including the seizure-onset zone (SOZ), modulation index (MI), and naming-related high-gamma activity. Modulation index, quantifying the coupling between high-frequency activity at >80 Hz and local slow wave at 3-4 Hz, effectively functions as a surrogate marker of the burden of interictal spike-and-slow-wave discharges. The mixed model specifically incorporated 'subtraction-MI', defined as the subtraction of mean z-score normalized MI across all preserved sites from that across all resected sites. Auditory naming-related high-gamma activity at 70-110 Hz is a biomarker to characterize the underlying language and speech function. The model incorporated 'maximum resected high-gamma', defined as the high-gamma percent change largest among sites included in the resected language-dominant hemispheric region. The model also incorporated the clinical and imaging profiles of given patients. The analysis revealed that complete removal of SOZ (p = 0.003) and younger patient age (p = 0.040) were independently associated with greater satisfaction. Neither 'subtraction-MI' nor 'maximum naming-related high-gamma' showed a significant and independent association with long-term satisfaction in our patient cohort. The observed impact of complete resection of SOZ and early surgery can be considered when counseling candidates for epilepsy surgery.

Keywords: High-frequency oscillations (HFOs); Intracerebral EEG; Pediatric epilepsy surgery; Phase-amplitude coupling; Ripples.

Grants and funding

R01 NS064033/NS/NINDS NIH HHS/United States