Aguila Carlos A, Lucas Alfredo, Lavelle Sarah, Pattnaik Akash R, Kim Juri, Ojemann William K S, Ma Devin, Josyula Mariam, Petillo Nina, LaRocque Joshua J, Sinha Saurabh R, Ellis Colin A, Parashos Alexandra, Gleichgerrcht Ezequiel, Davis Kathryn A, Litt Brian, Conrad Erin C
Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Center for Neuroengineering and Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Epilepsia. 2025 May 19. doi: 10.1111/epi.18462.
Mesial temporal lobe epilepsy is a common localization of drug-resistant epilepsy in adults. Patients often undergo intracranial electroencephalographic monitoring to confirm localization and determine candidacy for focal ablation or resection. Clinicians primarily base surgical decision-making on seizure onset patterns, with imaging abnormalities and information from interictal epileptiform discharge (spikes) used as ancillary data. How the morphology and timing of spikes within multielectrode sequences may inform surgical planning is unknown, in part due to the lack of measurement methods for large datasets. We hypothesized that patients with mesial temporal lobe epilepsy have a distinct mesial-to-lateral spike gradient that differentiates them from other epilepsy localizations.
In a multicenter study at the University of Pennsylvania and the Medical University of South Carolina, we analyzed the timing and morphology of spikes and seizure high-frequency energy ratio in 75 patients with drug-resistant epilepsy. We compared these features across patients with mesial temporal lobe epilepsy, temporal neocortical epilepsy, and other localizations.
A logistic regression model combining all features predicted a clinical localization of mesial temporal lobe epilepsy in unseen patients with an area under the receiver operating characteristic curve of .82 (compared to an area under the receiver operating characteristic curve of .70 for seizure-only features, DeLong test p = .08) and an average precision of .84. Spike rate was the most important feature in the combined model.
These findings advance surgical planning by demonstrating that quantitative spike analysis can effectively supplement seizure data in localizing mesial temporal lobe epilepsy. This approach could reduce reliance on prolonged seizure monitoring, potentially decreasing patient risk and hospitalization costs while improving surgical targeting. Our results support incorporating automated spike analysis into standard clinical workflows for epilepsy surgery evaluation.
内侧颞叶癫痫是成人药物难治性癫痫的常见定位类型。患者常需接受颅内脑电图监测以确认癫痫灶定位，并确定是否适合进行局灶性消融或切除手术。临床医生主要根据发作起始模式做出手术决策，将影像学异常以及发作间期癫痫样放电（棘波）信息作为辅助数据。多电极序列中棘波的形态和时间如何为手术规划提供信息尚不清楚，部分原因是缺乏针对大型数据集的测量方法。我们推测内侧颞叶癫痫患者具有独特的从内侧到外侧的棘波梯度，这使其与其他癫痫定位类型相区别。
在宾夕法尼亚大学和南卡罗来纳医科大学进行的一项多中心研究中，我们分析了75例药物难治性癫痫患者的棘波时间和形态以及发作高频能量比。我们比较了内侧颞叶癫痫、颞叶新皮质癫痫和其他定位类型患者的这些特征。
一个结合所有特征的逻辑回归模型预测未见过的患者内侧颞叶癫痫的临床定位，受试者操作特征曲线下面积为0.82（相比仅根据发作特征时受试者操作特征曲线下面积为0.70，德龙检验p = 0.08），平均精度为0.84。棘波发生率是组合模型中最重要的特征。
这些发现表明定量棘波分析可有效补充发作数据以定位内侧颞叶癫痫，从而推进手术规划。这种方法可减少对长时间发作监测的依赖，潜在地降低患者风险和住院费用，同时改善手术靶点定位。我们的结果支持将自动棘波分析纳入癫痫手术评估的标准临床工作流程。
