Passive and active markers of cortical excitability in epilepsy

Georgia Ramantani; M Brandon Westover; Stephen Gliske; Johannes Sarnthein; Sridevi Sarma; Yujiang Wang; Maxime O Baud; William C Stacey; Erin C Conrad

doi:10.1111/epi.17578

Passive and active markers of cortical excitability in epilepsy

Epilepsia. 2023 Dec;64 Suppl 3(Suppl 3):S25-S36. doi: 10.1111/epi.17578. Epub 2023 Mar 22.

Authors

Georgia Ramantani^{1

2}, M Brandon Westover^{3

4

5

6}, Stephen Gliske⁷, Johannes Sarnthein⁸, Sridevi Sarma⁹, Yujiang Wang¹⁰, Maxime O Baud¹¹, William C Stacey^{12

13

14}, Erin C Conrad^{15

16}

Affiliations

¹ Department of Neuropediatrics and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
² University of Zurich, Zurich, Switzerland.
³ Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
⁴ Department of Data Science, Massachusetts General Hospital McCance Center for Brain Health, Boston, Massachusetts, USA.
⁵ Research Affiliate Faculty, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA.
⁶ Research Affiliate Faculty, Broad Institute, Cambridge, Massachusetts, USA.
⁷ Department of Neurosurgery, University of Nebraska Medical Center, Omaha, Nebraska, USA.
⁸ Department of Neurosurgery, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
⁹ Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
¹⁰ Interdisciplinary Computing and Complex BioSystems, School of Computing Science, Newcastle University, Newcastle Upon Tyne, UK.
¹¹ Sleep-Wake-Epilepsy Center, NeuroTec, Center for Experimental Neurology, Department of Neurology, Inselspital Bern, University Hospital, University of Bern, Bern, Switzerland.
¹² Department of Neurology, BioInterfaces Institute, University of Michigan, Ann Arbor, Michigan, USA.
¹³ Department of Biomedical Engineering, BioInterfaces Institute, University of Michigan, Ann Arbor, Michigan, USA.
¹⁴ Division of Neurology, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.
¹⁵ Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
¹⁶ Department of Neurology, Penn Epilepsy Center, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.

PMID: 36897228
PMCID: PMC10512778 (available on 2024-12-01)
DOI: 10.1111/epi.17578

Abstract

Electroencephalography (EEG) has been the primary diagnostic tool in clinical epilepsy for nearly a century. Its review is performed using qualitative clinical methods that have changed little over time. However, the intersection of higher resolution digital EEG and analytical tools developed in the past decade invites a re-exploration of relevant methodology. In addition to the established spatial and temporal markers of spikes and high-frequency oscillations, novel markers involving advanced postprocessing and active probing of the interictal EEG are gaining ground. This review provides an overview of the EEG-based passive and active markers of cortical excitability in epilepsy and of the techniques developed to facilitate their identification. Several different emerging tools are discussed in the context of specific EEG applications and the barriers we must overcome to translate these tools into clinical practice.

Keywords: EEG biomarkers; cortical excitability; epilepsy; high-frequency oscillations; interictal spikes.

Passive and active markers of cortical excitability in epilepsy

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