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SCOPE-mTL: A non-invasive tool for identifying and lateralizing mesial temporal lobe seizures prior to scalp EEG
Alice D Lam1, Douglas Maus1, Sahar F Zafar1
1Epilepsy Division, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Objective:
In mesial temporal lobe (mTL) epilepsy, seizure onset can precede the appearance of a scalp EEG ictal pattern by many seconds. The ability to identify this early, occult mTL seizure activity could improve lateralization and localization of mTL seizures on scalp EEG.
Methods:
Using scalp EEG spectral features and machine learning approaches on a dataset of combined scalp EEG and foramen ovale electrode recordings in patients with mTL epilepsy, we developed an algorithm, SCOPE-mTL, to detect and lateralize early, occult mTL seizure activity, prior to the appearance of a scalp EEG ictal pattern.
Results:
Using SCOPE-mTL, 73% of seizures with occult mTL onset were identified as such, and no seizures that lacked an occult mTL onset were identified as having one. Predicted mTL seizure onset times were highly correlated with actual mTL seizure onset times (r=0.69). 50% of seizures with early mTL onset were lateralizable prior to scalp ictal onset, with 94% accuracy.
Conclusions:
SCOPE-mTL can identify and lateralize mTL seizures prior to scalp EEG ictal onset, with high sensitivity, specificity, and accuracy.
Significance:
Quantitative analysis of scalp EEG can provide important information about mTL seizures, even in the absence of a visible scalp EEG ictal correlate.
Insights
A new algorithm, SCOPE-mTL, detects early mesial temporal lobe (mTL) epilepsy seizure activity using scalp EEG before visible patterns emerge. This improves seizure localization and lateralization in mTL epilepsy patients.
Area of Science:
- Epilepsy research
- Neurology
- Signal processing
Background:
- Mesial temporal lobe (mTL) epilepsy seizures can have occult onset, preceding scalp EEG ictal patterns.
- Accurate lateralization and localization of mTL seizures are crucial for effective treatment.
Purpose of the Study:
- To develop an algorithm (SCOPE-mTL) for detecting and lateralizing early, occult mTL seizure activity using scalp EEG.
- To improve the identification of mTL seizure onset before scalp EEG ictal patterns appear.
Main Methods:
- Utilized scalp EEG spectral features and machine learning.
- Trained the SCOPE-mTL algorithm on combined scalp EEG and foramen ovale electrode recordings.
- Focused on patients with mTL epilepsy.
Main Results:
- SCOPE-mTL identified 73% of seizures with occult mTL onset.
- Predicted mTL seizure onset times strongly correlated with actual onset (r=0.69).
- 50% of early mTL onset seizures were lateralizable pre-scalp ictal onset with 94% accuracy.
Conclusions:
- SCOPE-mTL effectively identifies and lateralizes mTL seizures prior to scalp EEG ictal onset.
- The algorithm demonstrates high sensitivity, specificity, and accuracy.
- Quantitative scalp EEG analysis provides valuable information even without visible ictal correlates.
