We evaluated whether spike ripples, the combination of epileptiform spikes and ripples, provide a reliable and improved biomarker for the epileptogenic zone (EZ) compared to other leading interictal biomarkers in a multicenter, international study. We first validated an automated spike ripple detector on intracranial EEG recordings. We then applied this detector to subjects from four centers who subsequently underwent surgical resection with known 1-year outcomes. We evaluated the spike ripple rate in subjects cured after resection (ILAE 1 outcome) and those with persistent seizures (ILAE 2-6) across sites and recording types. We also evaluated available interictal biomarkers: spike, spike-gamma, wideband high frequency oscillation (HFO, 80-500 Hz), ripple (80-250 Hz), and fast ripple (250-500 Hz) rates using previously validated automated detectors. The proportion of resected events was computed and compared across subject outcomes and biomarkers. 109 subjects were included. Most spike ripples were removed in subjects with ILAE 1 outcome (P < 0.001), and this was qualitatively observed across all sites and for depth and subdural electrodes (P < 0.001, P < 0.001). Among ILAE 1 subjects, the mean spike ripple rate was higher in the RV (0.66/min) than in the non-removed tissue (0.08/min, P < 0.001). A higher proportion of spike ripples were removed in subjects with ILAE 1 outcomes compared to ILAE 2-6 outcomes (P = 0.06). Among ILAE 1 subjects, the proportion of spike ripples removed was higher than the proportion of spikes (P < 0.001), spike-gamma (P < 0.001), wideband HFOs (P < 0.001), ripples (P = 0.009) and fast ripples (P = 0.009) removed. At the individual level, more subjects with ILAE 1 outcomes had the majority of spike ripples removed (79%, 38/48) than spikes (69%, P = 0.12), spike-gamma (69%, P = 0.12), wideband HFOs (63%, P = 0.03), ripples (45%, P = 0.01), or fast ripples (36%, P < 0.001) removed. Thus, in this large, multicenter cohort, when surgical resection was successful, the majority of spike ripples were removed. Further, automatically detected spike ripples have improved specificity for epileptogenic tissue compared to spikes, spike-gamma, wideband HFOs, ripples, and fast ripples.

中文翻译：

---

尖峰波纹最能定位致癫痫区域：一项国际颅内研究

我们在一项多中心、国际研究中评估了与其他主要的发作间期生物标志物相比，棘波波纹（癫痫样棘波和波纹的组合）是否为致痫区（EZ）提供了可靠且改进的生物标志物。我们首先在颅内脑电图记录上验证了自动尖峰波纹检测器。然后，我们将该探测器应用于来自四个中心的受试者，这些受试者随后接受了手术切除，并获得了已知的 1 年结果。我们评估了切除后治愈的受试者（ILAE 1 结果）和持续性癫痫发作（ILAE 2-6）的受试者的不同部位和记录类型的尖峰波动率。我们还使用先前验证的自动检测器评估了可用的发作间期生物标志物：尖峰、尖峰-γ、宽带高频振荡（HFO，80-500 Hz）、纹波（80-250 Hz）和快速纹波（250-500 Hz）速率。计算并比较了切除事件的比例，并比较了受试者的结果和生物标志物。包括 109 名受试者。在具有 ILAE 1 结果的受试者中，大多数尖峰波纹被消除（P < 0.001），并且在所有部位以及深度和硬膜下电极上都定性观察到了这一点（P < 0.001，P < 0.001）。在 ILAE 1 受试者中，RV 中的平均尖峰波动率 (0.66/min) 高于未切除组织的平均峰值波动率 (0.08/min，P < 0.001)。与 ILAE 2-6 结果的受试者相比，ILAE 1 结果的受试者中去除尖峰波纹的比例更高 (P = 0.06)。在 ILAE 1 受试者中，去除尖峰波纹的比例高于尖峰 (P < 0.001)、尖峰伽马 (P < 0.001)、宽带 HFO (P < 0.001)、波纹 (P = 0.009) 的比例并消除快速纹波 (P = 0.009)。在个体层面，更多具有 ILAE 1 结果的受试者的大部分尖峰波纹被消除 (79%, 38/48)，而不是尖峰 (69%, P = 0.12)、尖峰伽玛 (69%, P = 0.12)、宽带去除了 HFO（63%，P = 0.03）、波纹（45%，P = 0.01）或快速波纹（36%，P < 0.001）。因此，在这个大型多中心队列中，当手术切除成功时，大部分尖峰波纹被去除。此外，与尖峰、尖峰伽马、宽带 HFO、波纹和快速波纹相比，自动检测的尖峰波纹提高了致癫痫组织的特异性。