In adult HUP SEEG, the first seizure did not localize the seizure onset zone worse than later seizures

We tested whether the first archived seizure localizes the clinician seizure onset zone (SOZ) less well than later seizures in an independent adult cohort. We analyzed archived per-pair feature time series from 99 seizures in 34 patients from the HUP cohort (OpenNeuro ds004100 v1.1.3). Mean single-seizure SOZ AUC was 0.714. The first-minus-later seizure AUC difference was +0.052 (95% CI +0.004 to +0.105; 21/34 patients positive; Holm-adjusted sign-flip p=0.052), so the pediatric finding of a lower first-seizure AUC did not replicate; the original estimate, -0.105, was outside this confidence interval. The multi-seizure average map improved AUC by +0.044 (95% CI +0.020 to +0.068; 30/34 patients; Holm-adjusted p=0.001). SOZ labels were identical across seizures in all 34 patients. Run number was assumed to indicate recording order, and this order could not be verified. Other limitations include seizure selection by dataset authors, labels derived from the same seizures, a 30-second baseline, and small outcome subgroups.

seizure onset zone · stereo-EEG · SEEG · epilepsy · line length · AUC · seizure order · multi-seizure mapping