Mapping Propagation of Interictal Spikes, Ripples, and Fast Ripples in Intracranial EEG of Children with Refractory Epilepsy.

Studies on intracranial electroencephalography (icEEG) recordings of patients with drug resistant epilepsy (DRE) show that epilepsy biomarkers propagate in time across brain areas. Here, we propose a novel method that estimates critical features of these propagations for different epilepsy biomarkers (spikes, ripples, and fast ripples), and assess their common onset as a reliable biomarker of the epileptogenic zone (EZ). For each biomarker, an automatic algorithm ranked the icEEG electrodes according to their timing occurrence in propagations and finally dichotomized them as onset or spread. We validated our algorithm on icEEG recordings of 8 children with DRE having a good surgical outcome (Engel score = 1). We estimated the overlap of the onset, spread, and entire zone of propagation with the resection (RZ) and the seizure onset zone (SOZ). Spike and ripple propagations were seen in all patients, whereas fast ripple propagations were seen in 6 patients. Spike, ripple, and fast ripple propagations had a mean duration of 28.3 ± 24.3 ms, 38.7 ± 37 ms, and 25 ± 14 ms respectively. Onset electrodes predicted the RZ and SOZ with higher specificity compared to the entire zone for all three biomarkers (p<0.05). Overlap of spike and ripple onsets presented a higher specificity than each separate biomarker onset: for the SOZ, the onsets overlap was more specific (97.89 ± 2.36) than the ripple onset (p=0.031); for the RZ, the onsets overlap was more specific (98.48 ± 1.5) than the spike onset (p=0.016). Yet, the entire zone for spike and ripple propagations predicted the RZ with higher sensitivity compared to each biomarker's onset (or spread) (p<0.05). We present, for the first time, preliminary evidence from icEEG data that fast ripples propagate in time across large areas of the brain. The onsets overlap of spike and ripple propagations constitutes an extremely specific (but not sensitive) biomarker of the EZ, compared to areas of spread (and entire areas) in propagation.