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© 2009 American Academy of Neurology High-frequency oscillations mirror disease activity in patients with epilepsyFrom Montreal Neurological Institute and Hospital (M.Z., J.J., R.Z., F.D., J.G.), McGill University, Montreal, Quebec, Canada; and Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht (M.Z.), The Netherlands. Address correspondence and reprint requests to Dr. Jean Gotman, Montreal Neurological Institute and Hospital, 3801 University St., Montreal, Quebec, Canada H3A 2B4 jean.gotman{at}mcgill.ca Objective: High-frequency oscillations (HFOs) can be recorded in epileptic patients with clinical intracranial EEG. HFOs have been associated with seizure genesis because they occur in the seizure focus and during seizure onset. HFOs are also found interictally, partly co-occurring with epileptic spikes. We studied how HFOs are influenced by antiepileptic medication and seizure occurrence, to improve understanding of the pathophysiology and clinical meaning of HFOs. Methods: Intracerebral depth EEG was partly sampled at 2,000 Hz in 42 patients with intractable focal epilepsy. Patients with five or more usable nights of recording were selected. A sample of slow-wave sleep from each night was analyzed, and HFOs (ripples: 80–250 Hz, fast ripples: 250–500 Hz) and spikes were identified on all artifact-free channels. The HFOs and spikes were compared before and after seizures with stable medication dose and during medication reduction with no intervening seizures. Results: Twelve patients with five to eight nights were included. After seizures, there was an increase in spikes, whereas HFO rates remained the same. Medication reduction was followed by an increase in HFO rates and mean duration. Conclusions: Contrary to spikes, high-frequency oscillations (HFOs) do not increase after seizures, but do so after medication reduction, similarly to seizures. This implies that spikes and HFOs have different pathophysiologic mechanisms and that HFOs are more tightly linked to seizures than spikes. HFOs seem to play an important role in seizure genesis and can be a useful clinical marker for disease activity. AED = antiepileptic drug; CBZ = carbamazepine; CLOB = clobazam; FR = fast ripple; FR_isol = fast ripples without co-occurring spikes; FR_Sp = fast ripples with co-occurring spikes; GBP = gabapentin; HFO = high-frequency oscillation; Lai/s = left anterior inferior/superior electrode (porencephalic cyst); LEV = levetiracetam; LF/p/a = left frontal/posterior/anterior electrode; LOP = left frontal operculum electrode; Lpi/s = left posterior inferior/superior electrode; L/RA = left/right amygdale electrode; L/RC/a/s = left/right cingulate/anterior/superior electrode; L/RE = left/right epidural electrode; L/RH = left/right hippocampus electrode; L/ROF = left/right orbitofrontal electrode; L/RO/i/s = left/right occipital/infracalcine/supracalcine electrode; L/RP = left/right parahippocampus electrode; L/RS = left/right supramarginal gyrus electrode; LSMAa/p = left supplementary motor area anterior/posterior electrode; LT = left anteriotemporal electrode; LTG = lamotrigine; OXC = oxcarbamazepine; PRI = primidone; PTH = phenytoin; R = ripple; R_isol = ripples without co-occurring spikes; R_Sp = ripples with co-occurring spikes; SEEG = stereo-EEG; SEZ = one or more seizures; SOZ = seizure onset zone; Sp = spike; TPM = topiramate.
Supplemental data at www.neurology.org Supported by grant MOP-10189 from the Canadian Institutes of Health Research and by the Netherlands Organization for Scientific Research AGIKO grant no. 92003481, the University Medical Center Utrecht (internationalization grant), and the "Stichting de drie lichten" (M.Z.). Disclosure: J.G. was a major shareholder of Stellate. The other authors report no disclosures. Received August 6, 2008. Accepted in final form November 25, 2008.
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