Adam Li, Chester Huynh, Zachary Fitzgerald, Iahn Cajigas, Damian Brusko, Jonathan Jagid, Angel Claudio, Andres Kanner, Jennifer Hopp, Stephanie Chen, Jennifer Haagensen, Emily Johnson, William Anderson, Nathan Crone, Sara Inati, Kareem Zaghloul, Juan Bulacio, Jorge Gonzalez-Martinez, and Sridevi V. Sarma
Over 3.4 million people in the US have epilepsy and 30% of these patients have drug-resistant epilepsy (DRE), where they do not respond to medication. DRE patients are burdened by epilepsy-related disabilities and frequently hospitalized constituting around $13 billion dollars annually spent for treating epilepsy patients in the USA. Successful surgical treatment necessitates complete elimination of the brain region(s) known as the seizure onset zone (SOZ). Between 30%-70% of patients continue to have seizures 6 months after treatment due to mislocalization of the SOZ. We developed neural fragility, an electroencephalogram (EEG) marker for the SOZ, and validated it in a retrospective study of 91 patients predicting surgical outcomes using neural fragility conditioned on the clinically labeled SOZ. Fragility predicted 43 out of the 47 surgical failures correctly and had an overall accuracy of 76%, compared to the clinical accuracy of 48% (successful outcomes). Neural fragility outperformed 20 other EEG features on the same set of cross-validation samples suggesting it as a potential EEG biomarker for the SOZ.