TY - JOUR
T1 - The value of intra-operative electrographic biomarkers for tailoring during epilepsy surgery
T2 - from group-level to patient-level analysis
AU - Demuru, Matteo
AU - Kalitzin, Stiliyan
AU - Zweiphenning, Willemiek
AU - van Blooijs, Dorien
AU - van’t Klooster, Maryse
AU - Van Eijsden, Pieter
AU - Leijten, Frans
AU - Zijlmans, Maeike
AU - Braun, Kees
AU - Ferrier, Cyrille
AU - Gebbink, Tineke
AU - Gosselaar, Peter
AU - Huiskamp, Geertjan
AU - van Klink, Nicole
AU - Ophorst, Janine
AU - van Rijen, Peter
AU - van der Salm, Sandra
AU - Winter, Anouk Velders de
N1 - Funding Information:
M. Demuru was supported by the Grant LSHM16054-SGF. M. Zijlmans was supported by the ERC starting Grant 803880
Publisher Copyright:
© 2020, The Author(s).
PY - 2020/9/4
Y1 - 2020/9/4
N2 - Signal analysis biomarkers, in an intra-operative setting, may be complementary tools to guide and tailor the resection in drug-resistant focal epilepsy patients. Effective assessment of biomarker performances are needed to evaluate their clinical usefulness and translation. We defined a realistic ground-truth scenario and compared the effectiveness of different biomarkers alone and combined to localize epileptogenic tissue during surgery. We investigated the performances of univariate, bivariate and multivariate signal biomarkers applied to 1 min inter-ictal intra-operative electrocorticography to discriminate between epileptogenic and non-epileptogenic locations in 47 drug-resistant people with epilepsy (temporal and extra-temporal) who had been seizure-free one year after the operation. The best result using a single biomarker was obtained using the phase-amplitude coupling measure for which the epileptogenic tissue was localized in 17 out of 47 patients. Combining the whole set of biomarkers provided an improvement of the performances: 27 out of 47 patients. Repeating the analysis only on the temporal-lobe resections we detected the epileptogenic tissue in 29 out of 30 combining all the biomarkers. We suggest that the assessment of biomarker performances on a ground-truth scenario is required to have a proper estimate on how biomarkers translate into clinical use. Phase-amplitude coupling seems the best performing single biomarker and combining biomarkers improves localization of epileptogenic tissue. Performance achieved is not adequate as a tool in the operation theater yet, but it can improve the understanding of pathophysiological process.
AB - Signal analysis biomarkers, in an intra-operative setting, may be complementary tools to guide and tailor the resection in drug-resistant focal epilepsy patients. Effective assessment of biomarker performances are needed to evaluate their clinical usefulness and translation. We defined a realistic ground-truth scenario and compared the effectiveness of different biomarkers alone and combined to localize epileptogenic tissue during surgery. We investigated the performances of univariate, bivariate and multivariate signal biomarkers applied to 1 min inter-ictal intra-operative electrocorticography to discriminate between epileptogenic and non-epileptogenic locations in 47 drug-resistant people with epilepsy (temporal and extra-temporal) who had been seizure-free one year after the operation. The best result using a single biomarker was obtained using the phase-amplitude coupling measure for which the epileptogenic tissue was localized in 17 out of 47 patients. Combining the whole set of biomarkers provided an improvement of the performances: 27 out of 47 patients. Repeating the analysis only on the temporal-lobe resections we detected the epileptogenic tissue in 29 out of 30 combining all the biomarkers. We suggest that the assessment of biomarker performances on a ground-truth scenario is required to have a proper estimate on how biomarkers translate into clinical use. Phase-amplitude coupling seems the best performing single biomarker and combining biomarkers improves localization of epileptogenic tissue. Performance achieved is not adequate as a tool in the operation theater yet, but it can improve the understanding of pathophysiological process.
UR - http://www.scopus.com/inward/record.url?scp=85090293354&partnerID=8YFLogxK
U2 - 10.1038/s41598-020-71359-2
DO - 10.1038/s41598-020-71359-2
M3 - Article
C2 - 32887896
SN - 2045-2322
VL - 10
JO - Scientific Reports
JF - Scientific Reports
IS - 1
M1 - 14654
ER -