Localizing the Epileptogenic Zone with Novel Biomarkers
Christos Papadelis1, M Scott Perry2
1Jane and John Justin Neurosciences Center, Cook Children's Health Care System, Fort Worth, TX; School of Medicine, Texas Christian University and University of North Texas Health Science Center, Fort Worth, TX; Department of Bioengineering, University of Texas at Arlington, Arlington, TX; Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Seminars in Pediatric Neurology
|October 8, 2021
Summary
Identifying the epileptogenic zone (EZ) in drug-resistant epilepsy (DRE) often requires multiple tests. New biomarkers show promise for precise EZ delineation and predicting surgical success in children with DRE.
Area of Science:
- Neuroscience
- Medical Imaging
- Epileptology
Background:
- Noninvasive methods like high-density EEG and MEG are standard for presurgical evaluation of the epileptogenic zone (EZ) in drug-resistant epilepsy (DRE).
- Current noninvasive techniques alone lack the reliability to precisely identify the EZ, often necessitating multimodal approaches.
- Intracranial electrode implantation (stereo-EEG, electrocorticography) is sometimes required for challenging DRE cases.
Purpose of the Study:
- To review recent technological advancements in presurgical neurophysiological evaluation for pediatric DRE.
- To highlight novel epilepsy biomarkers for improved EZ delineation and surgical outcome prediction.
- To discuss the clinical utility and limitations of advanced neurophysiological techniques.
Main Methods:
- Review of current literature on noninvasive and invasive neurophysiological methods for EZ localization.
- Emphasis on electric and magnetic source imaging (ESI/MSI).
- Discussion of high-frequency oscillations (HFOs) and functional connectivity (FC) as epilepsy biomarkers.
Main Results:
- Novel epilepsy biomarkers derived from electrophysiological data demonstrate potential for precise EZ delineation.
- These biomarkers can augment presurgical evaluations and predict surgical outcomes in DRE patients.
- Despite advancements, clinical adoption of these biomarkers remains limited.
Conclusions:
- Technological progress in neurophysiology offers enhanced tools for presurgical evaluation in pediatric DRE.
- Further research and validation are needed to integrate novel biomarkers into routine clinical practice.
- A multimodal approach incorporating advanced techniques is crucial for optimizing surgical planning in DRE.
