Epileptogenic high-frequency oscillations skip the motor area in children with multilobar drug-resistant epilepsy

•Occurrence rate of high-frequency oscillations [OR(HFO)] and modulation index [MI(3-4 Hz)] were significantly higher in resection areas in the good (vs. poor) outcome group.•The OR(HFO) and MI(3-4 Hz) skipped the motor area in children requiring subtotal hemispherectomy.•The OR(HFO) and MI(3-4 Hz) could be valuable biomarkers to identify epileptogenic extra-motor areas.

ObjectiveSubtotal hemispherectomy involves the resection of multiple lobes in children with drug-resistant epilepsy, skipping the motor area (MA). We determined epileptogenicity using the occurrence rate (OR) of high-frequency oscillations (HFOs) and the modulation index (MI), demonstrating strength of coupling between HFO and slow wave. We hypothesized that epileptogenicity increased over the multiple lobes but skipped the MA.MethodsWe analyzed 23 children (14 subtotal hemispherectomy; 9 multilobar resections). Scalp video-EEG and magnetoencephalography were performed before surgery. We analyzed the OR(HFO) and MI(5 phases=0.5-8 Hz) on electrodes of total area, resection areas, and MA. We compared the data between good [International League Against Epilepsy (ILAE) class I-II] and poor (III-VI) seizure outcome groups.ResultsILAE class Ia outcome was achieved in 18 children. Among the MI(5 phases) in the resection areas, MI(3-4 Hz) was the highest. The OR(HFO) and MI(3-4 Hz) in both total area and resection areas were significantly higher in the good seizure outcome group than in the poor outcome group. The OR(HFO) and MI(3-4 Hz) in resection areas were significantly higher than in the MA.ConclusionsOur patients with multilobar drug-resistant epilepsy showed evidence of multifocal epileptogenicity that specifically skipped the MA.SignificanceThis is the first study demonstrating that the electrophysiological phenotype of multifocal epilepsy specifically skips the MA using OR(HFO) and MI(3-4 Hz).