Resection of individually identified high‐rate high‐frequency oscillations region is associated with favorable outcome in neocortical epilepsy

Summary Objectives High‐frequency oscillations (HFOs) represent a novel electrophysiologic marker of endogenous epileptogenicity. Clinically, this propensity can be utilized to more accurately delineate the resection margin before epilepsy surgery. Currently, prospective application of HFOs is limited because of a lack of an exact quantitative measure to reliably identify HFO‐generating areas necessary to include in the resection. Here, we evaluated the potential of a patient‐individualized approach of identifying high‐rate HFO regions to plan the neocortical resection. Methods Fifteen patients with neocortical seizure‐onset zones (SOZs) underwent intracranial electroencephalographic monitoring. To identify interictal HFOs, we applied an automated, hypersensitive HFO‐detection algorithm followed by post hoc processing steps to reject false detections. The spatial relationship between HFO distribution and the SOZ was evaluated. To address high interpatient variability in HFO properties, we evaluated the high‐rate HFO region, an unbiased statistical parameter, in each patient. The relationship between resection of the high‐rate HFO region and postoperative outcome was examined. Results Grouped data demonstrated that the rate of ripple (60–200 Hz) and fast ripple (200–500 Hz) was increased in the SOZ (both p