Optimizing automated detection of high frequency oscillations using visual markings does not improve SOZ localization

Abstract

High frequency oscillations (HFOs) are a promising biomarker of epileptogenicity, and automated algorithms are critical tools for their detection. However, previously validated algorithms often exhibit decreased HFO detection accuracy when applied to a new data set, if the parameters are not optimized. This likely contributes to decreased seizure localization accuracy, but this has never been tested. Therefore, we evaluated the impact of parameter selection on seizure onset zone (SOZ) localization using automatically detected HFOs. We detected HFOs in intracranial EEG from twenty medically refractory epilepsy patients with seizure free surgical outcomes using an automated algorithm. For each patient, we assessed classification accuracy of channels inside/outside the SOZ using a wide range of detection parameters and identified the parameters associated with maximum classification accuracy. We found that only three out of twenty patients achieved maximal localization accuracy using conventional HFO detection parameters, and optimal parameter ranges varied significantly across patients. The parameters for amplitude threshold and root-mean-square window had the greatest impact on SOZ localization accuracy; minimum event duration and rejection of false positive events did not significantly affect the results. Using individualized optimal parameters led to substantial improvements in localization accuracy, particularly in reducing false positives from non-SOZ channels. We conclude that optimal HFO detection parameters are patient-specific, often differ from conventional parameters, and have a significant impact on SOZ localization. This suggests that individual variability should be considered when implementing automatic HFO detection as a tool for surgical planning.