Spike ripples localize the epileptogenic zone better than other leading biomarkers: a multicenter intracranial study
Bibliographic record
Abstract
Abstract Objective We evaluated whether the combination of epileptiform spikes and ripples (spike ripples) outperformed other leading biomarkers in identifying the epileptogenic zone across subjects in a multicenter international study. Methods We validated and applied an automated spike ripple detector on intracranial EEG recordings in subjects from 4 centers who subsequently underwent surgical resection with known 1-year seizure outcomes. We evaluated the spike ripple rate in subjects cured after resection (ILAE 1 outcome) and those with persistent seizures (ILAE 2-5) across sites and recording types. We also evaluated spike, wideband HFO (80-500 Hz), fast ripple (250-500 Hz), and ripple (80-250 Hz) rates using validated automated detectors. The proportion of resected events was computed and compared across subject outcomes and biomarkers. Results 109 subjects were included. The majority of spike ripples were removed in subjects with ILAE 1 outcome (p = 1e-6), and this was qualitatively observed across the four sites (p = 0.032, p = 0.092, p = 0.0005, p = 0.003) and the two electrode types (p = 0.01, p = 7e-6). A higher proportion of spike ripples were removed in subjects with ILAE 1 outcomes compared to ILAE 2-5 outcomes (p = 0.02). Among ILAE 1 subjects, the proportion of spike ripples removed was higher than the proportion of spikes (p = 0.0004), wideband HFOs (p = 0.0004), fast ripples (p = 0.008), and ripples (p = 0.008) removed. At the individual level, more subjects with ILAE 1 outcome had the majority of spike ripples removed (40/48, 83%) than spikes (69%, p = 0.04), wideband HFOs (63%, p = 0.009), fast ripples (36%, p = 2e-5), or ripples (45%, p = 0.0007) removed. Interpretation When surgical resection was successful, the majority of spike ripples were removed. Automatically detected spike ripples have improved specificity for epileptogenic tissue compared to spikes, wideband HFOs, fast ripples, and ripples.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.005 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".