Refining epileptogenic high-frequency oscillations using deep learning: a reverse engineering approach

Intracranially-recorded interictal high-frequency oscillations (HFOs) have been proposed as a promising spatial biomarker of the epileptogenic zone. However, visual verification of HFOs is time-consuming and exhibits poor inter-rater reliability. Furthermore, no method is currently available to distinguish HFOs generated from the epileptogenic zone (epileptogenic HFOs: eHFOs) from those generated from other areas (non-epileptogenic HFOs: non-eHFOs). To address these issues, we constructed a deep learning (DL)-based algorithm using HFO events from chronic intracranial electroencephalogram (iEEG) data via subdural grids from 19 children with medication-resistant neocortical epilepsy to: 1) replicate human expert annotation of artifacts and HFOs with or without spikes, and 2) discover eHFOs by designing a novel weakly supervised model (HFOs from the resected brain regions are initially labeled as eHFOs, and those from the preserved brain regions as non-eHFOs). The "purification power" of DL is then used to automatically relabel the HFOs to distill eHFOs. Using 12,958 annotated HFO events from 19 patients, the model achieved 96.3% accuracy on artifact detection (F1 score = 96.8%) and 86.5% accuracy on classifying HFOs with or without spikes (F1 score = 80.8%) using patient-wise cross-validation. Based on the DL-based algorithm trained from 84,602 HFO events from nine patients who achieved seizure-freedom after resection, the majority of such DL-discovered eHFOs were found to be HFOs with spikes (78.6%, p View larger version (81K): org.highwire.dtl.DTLVardef@39977dorg.highwire.dtl.DTLVardef@108b182org.highwire.dtl.DTLVardef@1bdf864org.highwire.dtl.DTLVardef@fe9e57_HPS_FORMAT_FIGEXP M_FIG C_FIG