Interictal HFO and FDG‐PET correlation predicts surgical outcome following SEEG

Abstract Objective This study aimed to investigate the quantitative relationship between interictal 18 F‐fluorodeoxyglucose–positron emission tomography (FDG‐PET) and interictal high‐frequency oscillations (HFOs) from stereo‐electroencephalography (SEEG) recordings in patients with refractory epilepsy. Methods We retrospectively included 32 patients. FDG‐PET data were quantified through statistical parametric mapping (SPM) t test modeling with normal controls. Interictal SEEG segments with four, 10‐min segments were selected randomly. HFO detection and classification procedures were automatically performed. Channel‐based HFOs separating ripple (80–250 Hz) and fast ripple (FR; 250–500 Hz) counts were correlated with the surrounding metabolism T score at the individual and group level, respectively. The association was further validated across anatomic seizure origins and sleep vs wake states. We built a joint feature FR × T reflecting the FR and hypometabolism concordance to predict surgical outcomes in 28 patients who underwent surgery. Results We found a negative correlation between interictal FDG‐PET and HFOs through the linear mixed‐effects model ( R 2 = .346 and .457 for ripples and FRs, respectively, p < .001); these correlations were generalizable to different epileptogenic‐zone lobar localizations and vigilance states. The FR × T inside the resection volume could be used as a predictor for surgical outcomes with an area under the curve of 0.81. Significance The degree of hypometabolism is associated with HFO generation rate, especially for FRs. This relationship would be meaningful for selection of SEEG candidates and for optimizing SEEG scheme planning. The concordance between FRs and hypometabolism inside the resection volume could provide prognostic information regarding surgical outcome.