A spatial perturbation framework to validate implantation of the epileptogenic zone

Kassem Jaber, Tamir Avigdor, Daniel Mansilla, Alyssa Ho, John Thomas, Chifaou Abdallah, Stephan Chabardes, Jeff Hall, Lorella Minotti, Philippe Kahane, Christophe Grova, Jean Gotman and Birgit Frauscher ()
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Kassem Jaber: McGill University
Tamir Avigdor: McGill University
Daniel Mansilla: Institute of Neurosurgery Dr. Asenjo
Alyssa Ho: McGill University
John Thomas: McGill University
Chifaou Abdallah: McGill University
Stephan Chabardes: Université Grenoble Alpes
Jeff Hall: McGill University
Lorella Minotti: Université Grenoble Alpes
Philippe Kahane: Université Grenoble Alpes
Christophe Grova: McGill University
Jean Gotman: McGill University
Birgit Frauscher: McGill University

Nature Communications, 2024, vol. 15, issue 1, 1-17

Abstract: Abstract Stereo-electroencephalography (SEEG) is the gold standard to delineate surgical targets in focal drug-resistant epilepsy. SEEG uses electrodes placed directly into the brain to identify the seizure-onset zone (SOZ). However, its major constraint is limited brain coverage, potentially leading to misidentification of the ‘true’ SOZ. Here, we propose a framework to assess adequate SEEG sampling by coupling epileptic biomarkers with their spatial distribution and measuring the system’s response to a perturbation of this coupling. We demonstrate that the system’s response is strongest in well-sampled patients when virtually removing the measured SOZ. We then introduce the spatial perturbation map, a tool that enables qualitative assessment of the implantation coverage. Probability modelling reveals a higher likelihood of well-implanted SOZs in seizure-free patients or non-seizure free patients with incomplete SOZ resections, compared to non-seizure-free patients with complete resections. This highlights the framework’s value in sparing patients from unsuccessful surgeries resulting from poor SEEG coverage.

Date: 2024
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DOI: 10.1038/s41467-024-49470-z

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