Objective: Characterization of progressive multi-site seizure recruitment using high frequency oscillations. Methods: Ictal and interictal high frequency oscillations were identified in a series of 13 patients with 72 seizures recorded by stereotactic depth electrodes, using previously validated methods. Channels with ictal high frequency oscillations were assigned to distinct spatial clusters, and seizure hubs were identified by stereotypically recruited non-overlapping clusters. Clusters were correlated with asynchronous seizure terminations to provide supportive evidence for independent seizure activity at these sites. The spatial overlap of ictal and interictal high frequency oscillations were compared. Results: Ictal high frequency oscillations were detected in 71% of seizures and 10% of implanted contacts, enabling tracking of contiguous and noncontiguous seizure recruitment. Multiple seizure hubs were identified in 54% of cases, including 43% of patients thought preoperatively to have unifocal epilepsy. Noncontiguous recruitment was associated with asynchronous seizure termination (Odds Ratio=10, 95% CI 2.9-41, p<0.001). Interictal high frequency oscillations demonstrated greater spatial overlap with ictal high frequency oscillations in cases with single seizure hubs than in those with multiple hubs (100% vs 66% per patient, p=0.03). Significance: Analysis of ictal high frequency oscillations can serve as a useful adjunctive technique to distinguish contiguous seizure spread from propagation to remote seizure sites. This study demonstrated that multiple seizure hubs were commonly identified by spatial clustering of ictal high frequency oscillations, including in cases that were considered unifocal. The distinction between initially activated and delayed seizure hubs was not evident based on interictal high frequency analysis, but may provide important prognostic information.

中文翻译：

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利用高频高频活动跟踪多部位癫痫发作的传播

目的：利用高频振荡表征进行性多部位癫痫发作的特征。方法：采用先前验证过的方法，通过立体定向深度电极对一系列13例72例癫痫发作的患者进行了高频和高频振荡检测。具有高频振荡的通道被分配给不同的空间簇，并且通过刻板地募集的非重叠簇来识别发作中心。聚类与异步癫痫发作终止相关，为这些部位的独立癫痫发作活动提供支持证据。比较了短波和短波高频振荡的空间重叠。结果：在71％的癫痫发作和10％的植入式触点中检测到了局部高频振荡，能够跟踪连续和不连续的癫痫发作募集。在54％的病例中发现了多个癫痫发作枢纽，其中43％的术前认为患有单灶性癫痫的患者。非连续募集与异步癫痫发作终止相关（赔率= 10，95％CI 2.9-41，p <0.001）。单发发作集线器的情况下，发作间期高频振荡与发作性高频振荡的空间重叠要大于多个发作中心的发作（100％vs 66％，p = 0.03）。启示：分析高频高频振荡可以作为一种有用的辅助技术，以区分连续性癫痫发作的传播和传播，从传播到偏远的癫痫发作。这项研究表明，通过发作性高频振荡的空间聚类通常可以识别出多个癫痫发作中心，包括在单焦点的情况下。基于发作间高频分析，最初激活的癫痫发作和延迟发作的癫痫发作之间没有明显区别，但可能提供重要的预后信息。