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Updated: Feb 6, 2026

Interictal High Frequency Oscillations Detected with Simultaneous Magnetoencephalography and Electroencephalography as Biomarker of Pediatric Epilepsy
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Removing high-frequency oscillations: A prospective multicenter study on seizure outcome.

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  • 1From the Department of Neuropediatrics and Muscular Diseases (J.J., M.M.) and Epilepsy Center (J.J., A.S.-B.), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; Division of Pediatric Neurology (J.Y.W., G.W.M.), David Geffen School of Medicine and Mattel Children's Hospital UCLA, Los Angeles, CA; and Montreal Neurological Institute (P.P., R.Z., F.D., J.G.), McGill University, Quebec, Canada. julia.jacobs@gmx.de.

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Predicting epilepsy surgery outcomes using high-frequency oscillations (HFOs) showed group-level correlation but failed individual prognostication. Further research is needed to refine HFO analysis for personalized seizure outcome prediction.

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Area of Science:

  • Neuroscience
  • Epileptology
  • Clinical Neurology

Background:

  • Interictal high-frequency oscillations (HFOs) are potential biomarkers for epileptic tissue.
  • Predicting postsurgical seizure outcomes is crucial for epilepsy surgery planning.

Purpose of the Study:

  • To evaluate the predictive value of interictal HFOs for postsurgical seizure outcomes in a prospective multicenter epilepsy surgery trial.
  • To determine if HFO-generating tissue resection correlates with seizure freedom.

Main Methods:

  • Fifty-two epilepsy patients from three centers were prospectively studied over one year.
  • HFOs (80-250 Hz ripples, 250-500 Hz fast ripples) were detected using intracranial EEG and electrocorticography.
  • Surgical planning and resection extent relative to HFO-generating regions were analyzed.

Main Results:

  • A group-level correlation was observed between resecting HFO-generating regions and seizure-free outcomes.
  • Individual seizure outcome prediction was inaccurate in 33% of patients (67% true prognostication).
  • Some patients achieved seizure freedom without resection of the majority of HFO-generating tissue.

Conclusions:

  • Individual prediction of epilepsy surgery outcomes based on HFOs was not consistently possible.
  • Current HFO analysis techniques may require refinement or HFOs may be less specific to epileptic tissue than previously thought.