In HUP SEEG, neural fragility weakly marks early seizure onset zones and underperforms simple features

We tested neural fragility (Li et al. 2021) as a marker of the clinician seizure onset zone (SOZ). Data: the first SEEG seizure of 36 HUP patients in OpenNeuro ds004100 (t = 85-132 s, onset at 120 s), fetched by byte range with SHA-256 provenance. For each 250 ms window, we fitted a ridge linear model of the bipolar pairs and calculated the minimum column perturbation that makes each pair unstable. Then we normalized it in the window. The unit is the patient (35 included). We calculated the SOZ-vs-other AUC per patient, used sign-flip tests and applied Holm correction. The plan was hashed before we calculated results. In the first 10 s of the seizure, fragility gave a small SOZ signal: mean AUC 0.58 (95% CI 0.52-0.64, Holm p = 0.017). The 30-100 Hz power increase (AUC 0.79) and line length (0.78) were better by about 0.2 (Holm p < 1e-4). In the 30 s before onset, SOZ pairs were LESS fragile than other pairs (AUC 0.32, Holm p < 1e-4). This is opposite to the hypothesis, and z-scoring over a clip that contains the seizure can cause part of it. Fragility did not separate seizure-free from not seizure-free patients (exploratory). Limits: one seizure per patient, clinician labels, our own implementation of the published equations, and a 0.25 s window step (a deviation from the plan).

neural fragility · epilepsy · seizure onset zone · stereo-EEG · SEEG · OpenNeuro · HUP · localization