title: The morphology of high frequency oscillations (HFO) does not improve delineating the epileptogenic zone.
abstract: OBJECTIVE
  We hypothesized that high frequency oscillations (HFOs) with irregular amplitude and frequency more specifically reflect epileptogenicity than HFOs with stable amplitude and frequency.
  
  
  METHODS
  We developed a fully automatic algorithm to detect HFOs and classify them based on their morphology, with types defined according to regularity in amplitude and frequency: type 1 with regular amplitude and frequency; type 2 with irregular amplitude, which could result from filtering of sharp spikes; type 3 with irregular frequency; and type 4 with irregular amplitude and frequency. We investigated the association of different HFO types with the seizure onset zone (SOZ), resected area and surgical outcome.
  
  
  RESULTS
  HFO rates of all types were significantly higher inside the SOZ than outside. HFO types 1 and 2 were strongly correlated to each other and showed the highest rates among all HFOs. Their occurrence was highly associated with the SOZ, resected area and surgical outcome. The automatic detection emulated visual markings with 93% true positives and 57% false detections.
  
  
  CONCLUSIONS
  HFO types 1 and 2 similarly reflect epileptogenicity.
  
  
  CONCLUSIONS
  For clinical application, it may not be necessary to separate real HFOs from "false oscillations" produced by the filter effect of sharp spikes. Also for automatically detected HFOs, surgical outcome is better when locations with higher HFO rates are included in the resection.
authors.affiliation: Neurosurgery Department, University Hospital Zurich, Zurich, Switzerland; Neuroscience Center, ETH and University of Zurich, Zurich, Switzerland; Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada. Electronic address: sergey.burnos@usz.ch.
authors.forename: Sergey
authors.initials: S
authors.lastname: Burnos
authors.affiliation: Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada.
authors.forename: Birgit
authors.initials: B
authors.lastname: Frauscher
authors.affiliation: Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada.
authors.forename: Rina
authors.initials: R
authors.lastname: Zelmann
authors.affiliation: MediCIS, INSERM, Faculté de Médecine, University of Rennes, Rennes, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Haegelen
authors.affiliation: Neurosurgery Department, University Hospital Zurich, Zurich, Switzerland; Neuroscience Center, ETH and University of Zurich, Zurich, Switzerland.
authors.forename: Johannes
authors.initials: J
authors.lastname: Sarnthein
authors.affiliation: Montreal Neurological Institute and Hospital, Montreal, Quebec, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Gotman
mesh_terms: D058256:Brain Waves / Q000502:physiology; D016208:Databases, Factual / Q000592:standards; D004569:Electroencephalography / Q000379:methods*; D004827:Epilepsy / Q000175:diagnosis* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male
keywords: Epilepsy; Filter effect; HFO; Ripple; Sharp spike; iEEG