View in EDS

Targeting interictal low‐entropy zones during epilepsy surgery predicts successful outcomes in pediatric drug‐resistant epilepsy.

Saved in:
Bibliographic Details
Title: Targeting interictal low‐entropy zones during epilepsy surgery predicts successful outcomes in pediatric drug‐resistant epilepsy.
Authors: Makaram, Navaneethakrishna (AUTHOR), Pesce, Matthew (AUTHOR), Tsuboyama, Melissa (AUTHOR), Bolton, Jeffrey (AUTHOR), Harmon, Joseph (AUTHOR), Papadelis, Christos (AUTHOR), Stone, Scellig (AUTHOR), Pearl, Phillip (AUTHOR), Rotenberg, Alexander (AUTHOR), Grant, Ellen P. (AUTHOR), Tamilia, Eleonora (AUTHOR)
Source: Epilepsia (Series 4). Jan2026, Vol. 67 Issue 1, p33-48. 16p.
Subjects: Epilepsy surgery, Electroencephalography, Childhood epilepsy, Brain mapping, Prognosis
Abstract: Objective: Approximately 40% of children undergoing epilepsy surgery have postoperative seizures, underscoring the need for enhanced estimators of the epileptogenic zone (EZ). We hypothesize that visually imperceptible low‐entropy activity in the interictal periods, even in the absence of conventional spikes, is a robust signature of the EZ. To test this, we mapped interictal "low‐entropy zones" using intracranial electroencephalography (iEEG) in children with drug‐resistant epilepsy (DRE) and assessed their value for postsurgical outcome prediction when targeted during surgery, along with their stability over prolonged periods. Methods: We analyzed iEEG data of 75 DRE children, including brief (5 min) data from patients with known Engel outcome (N = 59; used for outcome prediction) plus prolonged data from a separate recent cohort (N = 16; used for stability assessment). We estimated each contact's entropy across various frequencies (delta to fast‐ripple), pinpointed low‐entropy zones, and assessed whether their removal predicts outcome (3‐fold cross‐validation). In addition, the predictive value of entropy during non‐epileptiform (spike‐free) epochs was also assessed. Furthermore, established interictal estimators (spikes‐on‐ripple, fast ripples) were tested for outcome prediction. Using the prolonged dataset, we tested whether entropy distribution over brief epochs was similar to prolonged (3 h) data. Results: High overlap between low‐entropy zones and resection correlated with low Engel class (p < 0.0001, R = −0.54, N = 59), also during non‐epileptiform epochs (R = −0.52). Low‐entropy‐zone removal predicted outcomes with F1 score of 87% (p < 0.0001, N = 51; Engel I vs III–IV) outperforming spikes‐on‐ripple (F1 score = 82%, p = 0.002) or fast ripples (F1 score = 80%, p = 0.01). Low‐entropy zones retained high predictive value when non‐epileptiform epochs were used (F1 score = 89%, N = 44). Entropy distribution over brief epochs was strongly correlated with prolonged data (R > 0.8, p < 0.0001), and its relationship with seizure‐onset zone did not differ (brief vs prolonged data: p > 0.6). Significance: Surgically targeting low‐entropy zones accurately predicts the postoperative seizure outcomes of children with DRE. Mapping low‐entropy activity using brief iEEG segments shows consistency with using prolonged data and could enhance surgical planning in pediatric DRE. [ABSTRACT FROM AUTHOR]
Copyright of Epilepsia (Series 4) is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
FullText Text:
  Availability: 0
Header DbId: pbh
DbLabel: Psychology and Behavioral Sciences Collection
An: 191770524
AccessLevel: 6
PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
IllustrationInfo
Items – Name: Title
  Label: Title
  Group: Ti
  Data: Targeting interictal low‐entropy zones during epilepsy surgery predicts successful outcomes in pediatric drug‐resistant epilepsy.
– Name: Author
  Label: Authors
  Group: Au
  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Makaram%2C+Navaneethakrishna%22&quot;&gt;Makaram, Navaneethakrishna&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Pesce%2C+Matthew%22&quot;&gt;Pesce, Matthew&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Tsuboyama%2C+Melissa%22&quot;&gt;Tsuboyama, Melissa&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Bolton%2C+Jeffrey%22&quot;&gt;Bolton, Jeffrey&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Harmon%2C+Joseph%22&quot;&gt;Harmon, Joseph&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Papadelis%2C+Christos%22&quot;&gt;Papadelis, Christos&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Stone%2C+Scellig%22&quot;&gt;Stone, Scellig&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Pearl%2C+Phillip%22&quot;&gt;Pearl, Phillip&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Rotenberg%2C+Alexander%22&quot;&gt;Rotenberg, Alexander&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Grant%2C+Ellen+P%2E%22&quot;&gt;Grant, Ellen P.&lt;/searchLink&gt; (AUTHOR)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Tamilia%2C+Eleonora%22&quot;&gt;Tamilia, Eleonora&lt;/searchLink&gt; (AUTHOR)
– Name: TitleSource
  Label: Source
  Group: Src
  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22Epilepsia+%28Series+4%29%22&quot;&gt;Epilepsia (Series 4)&lt;/searchLink&gt;. Jan2026, Vol. 67 Issue 1, p33-48. 16p.
– Name: Subject
  Label: Subjects
  Group: Su
  Data: &lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Epilepsy+surgery%22&quot;&gt;Epilepsy surgery&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Electroencephalography%22&quot;&gt;Electroencephalography&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Childhood+epilepsy%22&quot;&gt;Childhood epilepsy&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Brain+mapping%22&quot;&gt;Brain mapping&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Prognosis%22&quot;&gt;Prognosis&lt;/searchLink&gt;
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: Approximately 40% of children undergoing epilepsy surgery have postoperative seizures, underscoring the need for enhanced estimators of the epileptogenic zone (EZ). We hypothesize that visually imperceptible low‐entropy activity in the interictal periods, even in the absence of conventional spikes, is a robust signature of the EZ. To test this, we mapped interictal &quot;low‐entropy zones&quot; using intracranial electroencephalography (iEEG) in children with drug‐resistant epilepsy (DRE) and assessed their value for postsurgical outcome prediction when targeted during surgery, along with their stability over prolonged periods. Methods: We analyzed iEEG data of 75 DRE children, including brief (5 min) data from patients with known Engel outcome (N = 59; used for outcome prediction) plus prolonged data from a separate recent cohort (N = 16; used for stability assessment). We estimated each contact&#39;s entropy across various frequencies (delta to fast‐ripple), pinpointed low‐entropy zones, and assessed whether their removal predicts outcome (3‐fold cross‐validation). In addition, the predictive value of entropy during non‐epileptiform (spike‐free) epochs was also assessed. Furthermore, established interictal estimators (spikes‐on‐ripple, fast ripples) were tested for outcome prediction. Using the prolonged dataset, we tested whether entropy distribution over brief epochs was similar to prolonged (3 h) data. Results: High overlap between low‐entropy zones and resection correlated with low Engel class (p &lt; 0.0001, R = −0.54, N = 59), also during non‐epileptiform epochs (R = −0.52). Low‐entropy‐zone removal predicted outcomes with F1 score of 87% (p &lt; 0.0001, N = 51; Engel I vs III–IV) outperforming spikes‐on‐ripple (F1 score = 82%, p = 0.002) or fast ripples (F1 score = 80%, p = 0.01). Low‐entropy zones retained high predictive value when non‐epileptiform epochs were used (F1 score = 89%, N = 44). Entropy distribution over brief epochs was strongly correlated with prolonged data (R &gt; 0.8, p &lt; 0.0001), and its relationship with seizure‐onset zone did not differ (brief vs prolonged data: p &gt; 0.6). Significance: Surgically targeting low‐entropy zones accurately predicts the postoperative seizure outcomes of children with DRE. Mapping low‐entropy activity using brief iEEG segments shows consistency with using prolonged data and could enhance surgical planning in pediatric DRE. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: &lt;i&gt;Copyright of Epilepsia (Series 4) is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=pbh&AN=191770524
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1111/epi.18636
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 16
        StartPage: 33
    Subjects:
      – SubjectFull: Epilepsy surgery
        Type: general
      – SubjectFull: Electroencephalography
        Type: general
      – SubjectFull: Childhood epilepsy
        Type: general
      – SubjectFull: Brain mapping
        Type: general
      – SubjectFull: Prognosis
        Type: general
    Titles:
      – TitleFull: Targeting interictal low‐entropy zones during epilepsy surgery predicts successful outcomes in pediatric drug‐resistant epilepsy.
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Makaram, Navaneethakrishna
      – PersonEntity:
          Name:
            NameFull: Pesce, Matthew
      – PersonEntity:
          Name:
            NameFull: Tsuboyama, Melissa
      – PersonEntity:
          Name:
            NameFull: Bolton, Jeffrey
      – PersonEntity:
          Name:
            NameFull: Harmon, Joseph
      – PersonEntity:
          Name:
            NameFull: Papadelis, Christos
      – PersonEntity:
          Name:
            NameFull: Stone, Scellig
      – PersonEntity:
          Name:
            NameFull: Pearl, Phillip
      – PersonEntity:
          Name:
            NameFull: Rotenberg, Alexander
      – PersonEntity:
          Name:
            NameFull: Grant, Ellen P.
      – PersonEntity:
          Name:
            NameFull: Tamilia, Eleonora
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 01
              Text: Jan2026
              Type: published
              Y: 2026
          Identifiers:
            – Type: issn-print
              Value: 00139580
          Numbering:
            – Type: volume
              Value: 67
            – Type: issue
              Value: 1
          Titles:
            – TitleFull: Epilepsia (Series 4)
              Type: main
ResultId 1