Scalp electroencephalogram analysis to determine the predictive value pathological of high frequency oscillations in children with epilepsy

• Applicant: Dr. Margarita Maltseva
• Subject Area: Clinical Neurology; Neurosurgery and Neuroradiology
• Term: since 2023
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 530582215

Innovative research has led to substantial advancement in diagnostics for epilepsy. Diagnosing epilepsy requires either recurrent seizures or a clear predisposition in a test called Electroencephalogram (EEG) which measures electrical brain activity. Repetitive seizures lead to secondary harm, such as cognitive decline and mental health comorbidities. Children with acquired brain injury, i.e. caused by stroke or due to lack of oxygen supply during birth, are at risk of developing epilepsy sometime after the injury. A novel EEG feature called high frequency oscillations (HFOs) has been researched as a marker for epilepsy. This oscillating brain activity occurs at the highest frequency and can be seen particularly well in children due to the structure of the scull. The markers, which are currently used in daily clinical routine, can be abundantly present even in the absence of epileptic seizures. Therefore, it is crucial to develop a more precise marker, to tailor therapeutic approach, avoid invasive diagnostics, and thus, improve the patient’s life quality. The findings of my last Walter Benjamin proposal showed that HFOs, non-invasively recorded from scalp EEG, correlate with epileptic disease activity in neonates as well as children of various ages. It has also identified the following key challenges, preventing translation from research settings into daily clinical routine: 1. Visual marking of HFO events is extremely time consuming and takes about 2h per 10 mins of EEG recording. 2. HFOs can also occur in healthy individuals, e.g. during memory processing, not linked to epilepsy; and clear distinction between healthy and epileptic HFOs is not yet possible. In my new proposal, I would like to focus on whether HFOs can predict patients who will develop epilepsy and therefore investigate two patient groups with a different type of brain injury. To address the main challenges outlined above, I would like to use an improved detection method, which we developed in the past year, to accelerate my analyses and increase efficiency. Moreover, I would like to further improve the detection by defining criteria to differentiate between healthy and epileptic HFOs. Establishing a reliable EEG-marker would revolutionize clinical practice in neurology and allow a precision medicine approach for all individuals affected by seizures. If we want to develop treatments that prevent further harm to brain cells caused by epilepsy, being able to assess emerging epileptic activity is a necessary stepping-stone.

• DFG Programme: WBP Fellowship
• International Connection: Canada
• Host: Professorin Dr. Julia Jacobs-LeVan