Non-harmonicity in high-frequency components of the intra-operative corticogram to delineate epileptogenic tissue during surgery

Abstract Objective We aimed to test the potential of auto-regressive model residual modulation (ARRm), an artefact-insensitive method based on non-harmonicity of the high-frequency signal, to identify epileptogenic tissue during surgery. Methods Intra-operative electrocorticography (ECoG) of 54 patients with refractory focal epilepsy were recorded pre- and post-resection at 2048 Hz. The ARRm was calculated in one-minute epochs in which high-frequency oscillations (HFOs; fast ripples, 250–500 Hz; ripples, 80–250 Hz) and spikes were marked. We investigated the pre-resection fraction of HFOs and spikes explained by the ARRm ( h 2 -index). A general ARRm threshold was set and used to compare the ARRm to surgical outcome in post-resection ECoG (Pearson X 2 ). Results ARRm was associated strongest with the number of fast ripples in pre-resection ECoG ( h 2  = 0.80, P 0.47 were associated with poor outcome at channel and patient level (both P Conclusions The ARRm algorithm might enable intra-operative delineation of epileptogenic tissue. Significance ARRm is the first unsupervised real-time analysis that could provide an intra-operative, ‘on demand’ interpretation per electrode about the need to remove underlying tissue to optimize the chance of seizure freedom.