title: Residual fast ripples in the intraoperative corticogram predict epilepsy surgery outcome.
abstract: OBJECTIVE
  We studied whether residual high-frequency oscillations (80-500 Hz; ripples, 80-250 Hz), especially fast ripples (FRs, 250-500 Hz), in post-resection intraoperative electrocorticography (ECoG) predicted seizure recurrence in comparison to residual interictal spikes and ictiform spike patterns.
  
  
  METHODS
  We studied, retrospectively, ECoG recorded at 2,048 Hz after resection in a cohort of patients with refractory focal epilepsy. We analyzed occurrence and number of residual FRs, ripples, interictal spikes, and ictiform spike patterns within the last minute of each recording and compared these to seizure recurrence.
  
  
  RESULTS
  We included 54 patients (median age 15.5 years) with 25 months median follow-up. Twenty-four patients had recurrent seizures. We found residual FRs, ripples, spikes, and ictiform spike patterns in 12, 51, 38, and 9 patients. Nine out of 12 patients with residual FRs had recurrent seizures (p = 0.016, positive predictive value 75%). Other ECoG events did not predict seizure recurrence. Patients with seizures had higher FR rates than seizure-free patients (p = 0.022). FRs near the resection and in distant pathologic areas could have changed the resection in 8 patients without harming functionally eloquent areas. One seizure-free patient had FRs in distant functionally eloquent areas.
  
  
  CONCLUSIONS
  Residual FRs in post-resection ECoG are prognostic markers for seizure recurrence, especially if their number is high. Tailoring could rely on FRs, but requires careful assessment of the ECoG, as FRs in functionally eloquent areas might not be pathologic.
authors.affiliation: From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (M.A.v.K., N.E.C.v.K., F.S.S.L., T.A.G., P.H.G., K.P.J.B., G.J.M.H., M.Z.), University Medical Center Utrecht; SEIN-Stichting Epilepsie Instellingen Nederland (M.Z.), Heemstede, the Netherlands; and Montreal Neurological Institute (R.Z.), McGill University, Montreal, Canada. m.a.vanhetklooster-2@umcutrecht.nl.
authors.forename: Maryse A
authors.initials: MA
authors.lastname: van 't Klooster
authors.affiliation: From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (M.A.v.K., N.E.C.v.K., F.S.S.L., T.A.G., P.H.G., K.P.J.B., G.J.M.H., M.Z.), University Medical Center Utrecht; SEIN-Stichting Epilepsie Instellingen Nederland (M.Z.), Heemstede, the Netherlands; and Montreal Neurological Institute (R.Z.), McGill University, Montreal, Canada.
authors.forename: Nicole E C
authors.initials: NE
authors.lastname: van Klink
authors.affiliation: From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (M.A.v.K., N.E.C.v.K., F.S.S.L., T.A.G., P.H.G., K.P.J.B., G.J.M.H., M.Z.), University Medical Center Utrecht; SEIN-Stichting Epilepsie Instellingen Nederland (M.Z.), Heemstede, the Netherlands; and Montreal Neurological Institute (R.Z.), McGill University, Montreal, Canada.
authors.forename: Frans S S
authors.initials: FS
authors.lastname: Leijten
authors.affiliation: From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (M.A.v.K., N.E.C.v.K., F.S.S.L., T.A.G., P.H.G., K.P.J.B., G.J.M.H., M.Z.), University Medical Center Utrecht; SEIN-Stichting Epilepsie Instellingen Nederland (M.Z.), Heemstede, the Netherlands; and Montreal Neurological Institute (R.Z.), McGill University, Montreal, Canada.
authors.forename: Rina
authors.initials: R
authors.lastname: Zelmann
authors.affiliation: From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (M.A.v.K., N.E.C.v.K., F.S.S.L., T.A.G., P.H.G., K.P.J.B., G.J.M.H., M.Z.), University Medical Center Utrecht; SEIN-Stichting Epilepsie Instellingen Nederland (M.Z.), Heemstede, the Netherlands; and Montreal Neurological Institute (R.Z.), McGill University, Montreal, Canada.
authors.forename: Tineke A
authors.initials: TA
authors.lastname: Gebbink
authors.affiliation: From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (M.A.v.K., N.E.C.v.K., F.S.S.L., T.A.G., P.H.G., K.P.J.B., G.J.M.H., M.Z.), University Medical Center Utrecht; SEIN-Stichting Epilepsie Instellingen Nederland (M.Z.), Heemstede, the Netherlands; and Montreal Neurological Institute (R.Z.), McGill University, Montreal, Canada.
authors.forename: Peter H
authors.initials: PH
authors.lastname: Gosselaar
authors.affiliation: From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (M.A.v.K., N.E.C.v.K., F.S.S.L., T.A.G., P.H.G., K.P.J.B., G.J.M.H., M.Z.), University Medical Center Utrecht; SEIN-Stichting Epilepsie Instellingen Nederland (M.Z.), Heemstede, the Netherlands; and Montreal Neurological Institute (R.Z.), McGill University, Montreal, Canada.
authors.forename: Kees P J
authors.initials: KP
authors.lastname: Braun
authors.affiliation: From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (M.A.v.K., N.E.C.v.K., F.S.S.L., T.A.G., P.H.G., K.P.J.B., G.J.M.H., M.Z.), University Medical Center Utrecht; SEIN-Stichting Epilepsie Instellingen Nederland (M.Z.), Heemstede, the Netherlands; and Montreal Neurological Institute (R.Z.), McGill University, Montreal, Canada.
authors.forename: Geertjan J M
authors.initials: GJ
authors.lastname: Huiskamp
authors.affiliation: From the Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery (M.A.v.K., N.E.C.v.K., F.S.S.L., T.A.G., P.H.G., K.P.J.B., G.J.M.H., M.Z.), University Medical Center Utrecht; SEIN-Stichting Epilepsie Instellingen Nederland (M.Z.), Heemstede, the Netherlands; and Montreal Neurological Institute (R.Z.), McGill University, Montreal, Canada.
authors.forename: Maeike
authors.initials: M
authors.lastname: Zijlmans
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004569:Electroencephalography; D004827:Epilepsy / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods*; D008297:Male; D011237:Predictive Value of Tests; D012008:Recurrence; D016896:Treatment Outcome; D055815:Young Adult