Early ictal line length marks clinical SOZ pairs and non-SOZ maps repeat across pediatric seizures

In an independent pediatric SEEG cohort, early ictal line-length increase distinguished clinician-labeled seizure onset zone (SOZ) pairs from other pairs, while the pre-ictal measure did not reach significance. Across 17 patients with usable SOZ comparisons, mean patient-level AUC was 0.74 for the 0–10 s ictal increase (95% CI for AUC−0.5: 0.14–0.33; 15/17 patients above 0.5; Holm-adjusted p=0.0012) and 0.57 for the 10 s before onset (95% CI for AUC−0.5: −0.02–0.16; p=0.149). In non-SOZ pairs, early-increase maps repeated across seizures in the same patient (mean Spearman rho=0.47, 15/17 positive; Holm-adjusted p=0.00018); the sham baseline map had mean rho=−0.04 (p=0.14). The analyses used archived 1–80 Hz line-length blocks for 54 seizures in 19 patients from OpenNeuro ds007445 v1.0.4, with the patient as the unit and a plan hashed before analysis. The SOZ comparison is partly circular because clinicians saw the same signal; it does not establish surgical value. Most files were sampled at 200 Hz, only the first three sessions per patient were used, and there was no outcome test.

pediatric epilepsy · stereo-EEG · seizure onset zone · line length · ictal · propagation · reproducibility