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Related Concept Videos

Epilepsy and Seizures: Overview01:24

Epilepsy and Seizures: Overview

Epilepsy is a chronic neurological disease marked by recurrent, unpredictable seizures. These seizures are caused by abnormal electrical discharges in the brain, leading to behavior, sensation, or consciousness alterations. They can also cause transient impairment of awareness, interfering with daily activities.
Various factors can trigger epilepsy, including genetic factors, brain damage, metabolic causes, and unknown etiology. Diagnosis of epilepsy involves electroencephalography (EEG), which...

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Methods for Identifying Epilepsy Surgery Targets Using Invasive EEG: A Systematic Review.

Karla Ivankovic1,2, Alessandro Principe1,2, Riccardo Zucca1,3

  • 1Department of Medicine and Life Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain.

Biomedicines
|November 27, 2024
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Summary

Quantitative EEG (qEEG) biomarkers show promise for drug-resistant epilepsy surgery, but study designs need standardization. Improving protocols enhances biomarker reliability and clinical adoption for better patient outcomes.

Keywords:
biomarkersepilepsy surgeryinvasive EEGoutcome predictionpharmacoresistant epilepsyquantitative EEG

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Area of Science:

  • Neuroscience
  • Epileptology
  • Biomarker Discovery

Background:

  • Pre-surgical evaluation for drug-resistant epilepsy yields seizure freedom in only 50-60% of patients.
  • There is a critical need for quantitative intracranial EEG (qEEG) biomarkers to identify epileptogenicity.
  • This review evaluates qEEG study designs, barriers to biomarker adoption, and proposes protocol refinements.

Purpose of the Study:

  • To review and evaluate the design of quantitative intracranial EEG (qEEG) studies.
  • To identify barriers hindering the clinical adoption of qEEG biomarkers.
  • To propose standardized qEEG study protocols for improved biomarker validation.

Main Methods:

  • Systematic review of MEDLINE and Scopus (2017-2023) for prognostic studies on qEEG markers.
  • Inclusion of exploratory and prediction studies targeting the epileptogenic network.
  • Extraction of cohort parameters, ground truth references, and analytical approaches.

Main Results:

  • 128 studies were included, revealing highly heterogeneous designs and small median cohort sizes (16 patients).
  • Only 25 studies validated markers through post-surgical outcome prediction; performance decreased with larger cohorts.
  • Longer follow-up and connectivity-based approaches correlated with higher prediction accuracy; data/code availability was low (9%).

Conclusions:

  • Standardizing study designs, akin to clinical trials, is crucial for enhancing qEEG marker validation.
  • Recommendations include using consecutive cohorts, long-term follow-up, and validating against surgical resection.
  • These standardized approaches will improve the reliability and clinical adoption of qEEG biomarkers for epilepsy surgery.