Abstract Objective To evaluate whether scalp oscillatory patterns—particularly scalp fast oscillations (SFOs) (>30 Hz) detected using 256‐channel high‐density EEG (HD‐EEG)—are associated with and can predict surgical outcomes in patients with drug‐resistant temporal lobe epilepsy with hippocampal sclerosis (TLE‐HS) undergoing anterior temporal lobectomy (ATL). Method This prospective cohort study included 47 patients with drug‐resistant TLE‐HS who underwent HD‐EEG and subsequent ATL with at least 24 months of postoperative follow‐up. A total of 70 averaged interictal epileptiform discharges (IEDs) were analyzed using time–frequency methods. Scalp oscillation frequencies across anterior temporal, posterior temporal, and extratemporal regions were calculated, and cluster analysis was performed to identify significant patterns. Scalp fast oscillations (SFOs; >30 Hz) were separately analyzed. Associations with surgical outcomes were assessed using generalized linear mixed models, and diagnostic performance was evaluated. Results A total of 70 averaged IEDs from 47 patients were analyzed. Patients with seizure recurrence exhibited higher median scalp oscillation frequencies across anterior temporal (34.26 Hz), posterior temporal (29.47 Hz), and extratemporal regions (25.25 Hz) compared to seizure‐free patients (12.50, 7.56, and 9.17 Hz, respectively). Among 22 IEDs with SFOs (>30 Hz), cluster‐based analysis identified a specific frequency pattern significantly associated with surgical outcome ( p = 0.031). This SFO‐based pattern independently predicted seizure recurrence (odds ratio = 12.60, 95% CI: 1.19–133.89, p = 0.036), with a sensitivity of 87.5%, specificity of 64.3%, and an area under the receiver operating characteristic curve of 0.759. Significance This study demonstrates that specific scalp oscillatory patterns, particularly SFOs detected via 256‐channel HD‐EEG, are predictive of surgical outcomes in TLE‐HS. These findings suggest that scalp oscillation analysis may serve as a valuable, noninvasive biomarker in the presurgical evaluation of epilepsy and could aid in delineating the extent of the epileptogenic network. Plain Language Summary In this study, we used advanced brainwave recordings (called high‐density EEG) to examine electrical patterns in the brains of people with epilepsy. We found that certain fast brainwave signals were linked to whether surgery could stop seizures. These signals may help doctors better plan epilepsy surgery in the future.
Kongsakorn et al. (Fri,) studied this question.