Seizure localization for epilepsy surgery using high frequency electrophysiological markers

使用高频电生理标记进行癫痫手术的癫痫发作定位

• 批准号: 10211944
• 负责人: Beth Ann Lopour
• 金额: $ 44.8万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-15 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10211944
• 关键词: Accounting; Antiepileptic Agents; Area; Biological Markers; Blinded; Brain; Brain imaging; Brain region; Characteristics; Classification; Clinical; Clinical Trials; Complex; Coupled; Data; Decision Making; Detection; Electrocorticogram; Electrodes; Electroencephalography; Electrophysiology (science); Epilepsy; Event; Excision; Failure; Freedom; Frequencies; Goals; High Frequency Oscillation; Implant; Implanted Electrodes; Individual; Intuition; Knowledge; Lead; Measurement; Measures; Methodology; Methods; Modeling; Monitor; Morphology; Operative Surgical Procedures; Outcome; Pathologic; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Physiological; Postoperative Period; Procedures; Prospective Studies; Quality of life; Recommendation; Research; Resected; Seizures; Sensitivity and Specificity; Signal Transduction; Specificity; Surface; Surgeon; Surgical Management; Techniques; Testing; Tissues; Vision; Work; base; brain electrical activity; brain tissue; childhood epilepsy; clinical implementation; computerized tools; density; feature detection; high standard; improved; improved outcome; minimally invasive; neurotransmission; novel; prospective; risk minimization; simulation

PROJECT SUMMARY/ABSTRACT In the most severe cases of epilepsy, where seizures persist despite multiple trials of anti-seizure medications, patients may benefit from surgical removal of seizure-generating brain tissue. Prior to surgery, electrodes are often implanted directly into or onto the patient’s brain and are used to continuously record electrical brain activity over days. This is done to capture seizure activity and determine its point of origin, i.e. the seizure onset zone. If the seizure onset zone is identified, clinicians then use this information, in combination with the results of brain imaging and other testing, to guide removal of the corresponding brain tissue. While epilepsy surgery may lead to seizure freedom, 70-90% of surgery patients remain on anti-seizure medications and roughly 50% of patients continue to have seizures. The long-term goal of this work is to improve the outcomes of patients undergoing epilepsy surgery by developing more accurate methods to localize seizure-generating tissue. High frequency oscillations (HFOs) have garnered considerable excitement for their potential to identify and localize epileptogenic brain tissue. HFOs are short bursts of high-frequency electrical activity that occur in the brains of patients with epilepsy. They occur more frequently in the epileptogenic zone (EZ, the hypothetical area that must be excised to attain post-operative seizure freedom), and surgically removing HFO-generating brain tissue increases the likelihood of seizure freedom. While ongoing clinical trials are attempting to assess their prospective value for epilepsy surgery planning, there are multiple barriers to their widespread use. While group-level results are robust, HFO analysis is not yet predictive for single subjects. Recordings lack the sensitivity to reliably measure HFOs in every patient, and the occurrence of non-epileptic HFOs confounds the results. Therefore, HFOs are poised to revolutionize epilepsy surgery, but there is a critical need to optimize their measurement and maximize single-subject accuracy. The overall objective of this proposal is to improve EZ localization accuracy through systematic determination of the optimal HFO measurement methodology, coupled with novel, robust methods for HFO analysis. The rationale is that developing these novel methods with improved measurement techniques will increase the accuracy and robustness of HFOs as a biomarker of the seizure onset zone, thus improving the surgical management of epilepsy. To attain our objective, we will pursue three specific aims: (1) Demonstrate that electrode size is a crucial factor in HFO measurement. (2) Develop an automated method for patient-specific localization of the EZ based on HFOs. (3) Evaluate the effects of electrode size and HFO analysis method on EZ localization. The proposed research is significant because it will provide specific recommendations for the measurement and analysis of HFOs, enabling accurate, detailed localization of epileptogenic brain tissue. The expected outcome of this work is that it will guide surgeons in choosing which brain regions to remove and will increase the pool of potential surgical candidates. Overall, this will have a positive impact by leading to a greater chance of seizure freedom and improved quality of life for patients with the most severe cases of epilepsy.

项目摘要/摘要 在最严重的癫痫病例中，癫痫发作持续了目的地多次试验抗癫痫药物， 患者可以通过手术去除癫痫发作的脑组织受益。手术前，电极是 通常直接植入患者的大脑中，并用于继续记录电动大脑 几天的活动。这样做是为了捕获癫痫发作并确定其起源点，即癫痫发作 发作区。如果确定了癫痫发作区域，则临床医生，然后将此信息与 大脑成像和其他测试的结果，以指导去除相应的脑组织。而癫痫 手术可能导致癫痫发作自由，70-90％的手术患者保留在抗塞氏菌药物中， 大约50％的患者继续癫痫发作。这项工作的长期目标是改善结果 通过开发更准确的方法来定位癫痫发作，接受癫痫手术的患者 组织。高频振荡（HFO）引起了极大的兴奋，因为它们的潜力 并定位癫痫脑组织。 HFOS是出现在高频电活动的短爆发 癫痫患者的大脑。它们发生在癫痫发作区（EZ，假设 必须获得术后癫痫发作自由的领域，并通过手术删除HFO生成 脑组织增加了癫痫发作自由的可能性。虽然正在进行的临床试验试图评估 它们对癫痫手术计划的预期价值，其宽度的使用有多个障碍。尽管 小组级的结果是可靠的，HFO分析尚未预测单个受试者。录音缺乏 对每位患者的可靠测量HFO的敏感性，非癫痫性HFO的出现会混淆 结果。因此，HFO被中毒以彻底改变癫痫手术，但是有迫切需要优化 它们的测量并最大化单个受试者的精度。该提议的总体目的是改善 通过系统地确定最佳HFO测量方法，EZ定位精度， 再加上新型的强大方法用于HFO分析。理由是开发这些新颖的方法 通过改进的测量技术将提高HFO作为生物标志物的准确性和鲁棒性 癫痫发作区，从而改善了癫痫的手术管理。为了实现我们的目标，我们将 追求三个特定目的：（1）证明电极大小是HFO测量的关键因素。 （2） 开发一种基于HFO的EZ特定于患者定位的自动化方法。 （3）评估 电极大小和HFO分析方法对EZ定位的影响。拟议的研究很重要 因为它将为HFO的测量和分析提供具体的建议，以实现 癫痫脑组织的准确，详细的定位。这项工作的预期结果是它将 指导外科医生选择要去除哪些大脑区域并增加潜在手术的库 候选人。总体而言，这将带来更大的扣押自由和更大的机会，从而产生积极影响 患有癫痫病例最严重的患者的生活质量改善。