In 16 pediatric SEEG patients, the earliest archived seizure had lower SOZ AUC than later seizures, while averaging three seizures added 0.027 AUC

We analyzed archived early-ictal line-length maps from 48 seizures in 16 pediatric SEEG patients (OpenNeuro ds007445 v1.0.4; three seizures per patient) to assess how well SOZ and non-SOZ electrode pairs were ranked. SOZ labels varied between seizures in 8 of 16 patients, so the primary target was the union of each patient’s per-seizure SOZ labels, a documented change from the pre-analysis plan. Mean single-seizure AUC was 0.76. Averaging three seizures increased AUC by 0.027 (95% CI 0.005 to 0.051; Holm p=0.045), but the pre-registered criterion for concluding that the gain was below 0.03 was not met. The gain was absent when scoring each seizure against its own SOZ labels (+0.016, p=0.51) and among patients whose labels were consistent across seizures (+0.005, p=0.56). The earliest archived seizure had lower AUC than later seizures in 11 of 16 patients (difference -0.105, 95% CI -0.189 to -0.026; Holm p=0.045). Against each seizure’s own labels, the difference was -0.184 in 13 of 16 patients (p=0.0004; exploratory). This result was unchanged across 0–5, 0–10, and 0–20 s early-ictal windows. The study included 16 patients and three seizures per patient; labels came from the same seizures as the maps, session number was assumed to represent recording order, and causes of the first-seizure effect were not tested.

pediatric epilepsy · SEEG · seizure onset zone · line length · AUC · ictal mapping · OpenNeuro