Visual Features in Stereo-Electroencephalography to Predict Surgical Outcome: A Multicenter Study.
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2025-06
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Epilepsy surgery needs predictive features that are easily implemented in clinical practice. Previous studies are limited by small sample sizes, lack of external validation, and complex computational approaches. We aimed to identify and validate visually stereo-electroencephalography (SEEG) features with the highest predictive value for surgical outcome, and assess the reliability of their visual extraction.Methods
We included 177 patients with drug-resistant epilepsy who underwent SEEG-guided surgery at 4 epilepsy centers. We assessed the predictive performance of 10 SEEG features from various SEEG periods for surgical outcome, using the area under the receiver operating characteristic curve, and considering resected channels and surgical outcome as the gold standard. Findings were validated externally using balanced accuracy. Six experts, blinded to outcome, evaluated the visual reliability of the optimal feature using interrater reliability, percentage agreement (standard deviation ± SD) and Gwet's kappa (κ ± SD).Results
The derivation cohort comprised 100 consecutive patients, each with at least 1-year of postoperative follow up (40% temporal lobe epilepsy; 42% Engel Ia). Spatial co-occurrence of gamma spikes and preictal spikes emerged as the optimal predictive feature of surgical outcome (area under the receiver operating characteristic curve 0.82). Applying the optimized threshold from the derivation cohort, external validation in 2 datasets showed similar performances (balanced accuracy 69.2% and 73.2%). Expert interrater reliability for gamma spikes (percentage agreement, 96% ± 2%; κ, 0.63 ± 0.16) and preictal spikes (percentage agreement, 92% ± 2%; κ, 0.65 ± 0.18) were substantial.Interpretation
Spatial co-occurrence of gamma spikes and preictal spikes predicts surgical outcome. These visually identifiable features may reduce the burden of SEEG analysis by reducing analysis time, and improve outcome by guiding surgical resection margins. ANN NEUROL 2025.Type
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Abdallah, Chifaou, John Thomas, Olivier Aron, Tamir Avigdor, Kassem Jaber, Irena Doležalová, Daniel Mansilla, Päivi Nevalainen, et al. (2025). Visual Features in Stereo-Electroencephalography to Predict Surgical Outcome: A Multicenter Study. Annals of neurology. 10.1002/ana.27278 Retrieved from https://hdl.handle.net/10161/33038.
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Prachi T. Parikh
Birgit Frauscher
Dr. Birgit Frauscher is a clinician scientist whose career is dedicated to improve diagnosis and prognosis of people with epilepsy by developing new methods based on advanced electroencephalography techniques to better localize the epileptic focus in order to improve epilepsy treatment outcomes and ultimately achieve the best possible quality of life. She is currently holding the position of Director of the Duke Comprehensive Epilepsy Center and holds a secondary appointment with the Department of Biomedical Engineering at the Duke Pratt School of Engineering.
Her academic journey started at the Medical University of Innsbruck in Austria, where she accomplished her medical training, residency in neurology, and subspecialty training in electroencephalography, epilepsy and sleep medicine. Early in her career during Medical School she became fascinated by the technique of electroencephalography and how it allows to draw important conclusions on brain function. After completion of her clinical training in 2008, she underwent subsequent research training resulting in the successful completion of her habilitation degree in 2011. To specialize on intracranial EEG and signal analysis, she spent a visiting professorship at the Montreal Neurological Institute and Hospital, McGill University in Canada between 2013 – 2015. Subsequently, she served at the Montreal Neurological Institute and Hospital as an Attending Epileptologist and later as Group Leader of Epilepsy and Professor of Neurology.
Her research interests include i) the development of novel seizure-independent EEG markers for the epileptogenic zone in order to achieve a more accurate diagnosis of epilepsy, ii) the investigation of the important interactions between sleep and epilepsy, and iii) the use of the unique possibility of invasive intracranial EEG for studying brain physiology during wakefulness and sleep in order to better delineate normal from abnormal intracranial EEG activity.
Dr. Frauscher’s publication record holds over 170 peer-reviewed papers dedicated to epilepsy and sleep with a H-index of 62. Her scholarly endeavors have earned her several prestigious awards, including Clinician-Scientist awards of the FRSQ (2018-2023), the Michael Prize of the International League against Epilepsy (2019) and the Ernst Niedermeyer Prize from the Austrian Epilepsy Society (2015). Dr. Frauscher's dedication to pushing the boundaries of epilepsy and sleep research highlights her standing in the field and her significant contributions to advancing clinical knowledge.
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