Objective
Lowâvoltage fast activity (LVF) and lowâfrequency highâamplitude periodic spiking (PS) are the two most common seizureâonset patterns in mesiotemporal lobe epilepsy, with different underlying mechanisms, pathology, and postsurgical outcome. The present work aims to investigate whether specific coupling patterns of highâfrequency oscillations (HFOs >80 Hz) and lowâfrequency waves in the interictal period may distinguish these two patterns, and also seizureâonset zone (SOZ) from nonâSOZ as a secondary aim.
Methods
We used intracranial electroencephalography (iEEG) data (during nonârapid eye movement [NREM] sleep) of 18 patients with either LVF or PS seizureâonset patterns. We investigated the interaction between HFOs (ripples: 80â250Â Hz and fast ripples: >250Â Hz) and slow oscillations (slowâdelta, delta, and theta waves). We compared classic features (amplitude, duration, frequency, and power) and phase of coupling between HFOs and slower oscillations inside and outside the SOZ. We then used these features to classify HFOs and subsequently patients into LVF and PS groups.
Results
Ripples in the LVF group had significantly longer duration, lower frequency, and higher amplitude than in the PS group. The phase of slow oscillations at which HFOs occur is different between the LVF and PS HFOs (LVF, mostly at the peak or the transition of peak to trough; PS, mostly during the transition of trough to peak). HFOs associated with theta waves best discriminate seizureâonset patterns. The coupling phase improves the classification of HFOs and patients to either LVF or PS groups, and also the classification of HFOs in SOZ and nonâSOZ.
Significance
The phase of coupling of HFOs and lowâfrequency waves may help to not only identify the SOZ, but also to classify patients with different types of seizureâonset patterns. It likely reflects that different disease processes are involved in these patterns during the interictal period.