Interictal ripples nested in epileptiform discharge help to identify the epileptogenic zone in neocortical epilepsy

- A complete removal of type I ripples was associated with seizure freedom in neocortical epilepsy.
- Fast ripples help localize the epileptogenic zone despite being less frequently detected.
- EEG characteristics associated with ripples help classify ripples with different epileptogenicity.

ObjectiveThis study aimed to identify the subtype of interictal ripples that help delineate the epileptogenic zone in neocortical epilepsy.MethodsTotally 25 patients with focal neocortical epilepsy who had invasive electroencephalography (EEG) evaluation and subsequent surgery were included. They were followed up for at least 2 years. Interictal ripples (80-250 Hz) and fast ripples (250-500 Hz) during slow-wave sleep were identified. Neocortical ripples were defined as type I ripples when they were superimposed on epileptiform discharges, and as type II ripples when they occurred independently. Resection ratio was calculated to present the extent to which the cortical area showing an interictal event or the seizure onset zone (SOZ) was completely removed.ResultsFast ripples and types I and II ripples were found in 8, 19, and 21 patients, respectively. Only the higher resection ratio of interictal fast or type I ripples was correlated to the Engel 1a surgical outcome.ConclusionsType I ripples could assist in localizing the epileptogenic zone in neocortical epilepsy.SignificanceType I and fast ripples both may be pathological high-frequency oscillations.