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However, there are often multiple spike populations whose frequencies change over time, influenced by brain state. Understanding state changes in spike rates will improve our ability to use spikes for surgical planning. Our goal was to determine the effect of sleep and seizures on interictal spikes, and to use sleep and seizure\u2010related changes in spikes to localize the seizure\u2010onset zone (SOZ).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a retrospective analysis of intracranial electroencephalography (EEG) data from patients with focal epilepsy. We automatically detected interictal spikes and we classified different time periods as awake or asleep based on the ratio of alpha to delta power, with a secondary analysis using the recently published SleepSEEG algorithm. We analyzed spike rates surrounding sleep and seizures. We developed a model to localize the SOZ using state\u2010dependent spike rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We analyzed data from 101 patients (54 women, age range 16\u201369). The normalized alpha\u2010delta power ratio accurately classified wake from sleep periods (area under the curve\u00a0=\u00a0.90). Spikes were more frequent in sleep than wakefulness and in the post\u2010ictal compared to the pre\u2010ictal state. Patients with temporal lobe epilepsy had a greater wake\u2010to\u2010sleep and pre\u2010 to post\u2010ictal spike rate increase compared to patients with extra\u2010temporal epilepsy. A machine\u2010learning classifier incorporating state\u2010dependent spike rates accurately identified the SOZ (area under the curve\u00a0=\u00a0.83). Spike rates tended to be higher and better localize the seizure\u2010onset zone in non\u2013rapid eye movement (NREM) sleep than in wake or REM sleep.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>The change in spike rates surrounding sleep and seizures differs between temporal and extra\u2010temporal lobe epilepsy. Spikes are more frequent and better localize the SOZ in sleep, particularly in NREM sleep. Quantitative analysis of spikes may provide useful ancillary data to localize the SOZ and improve surgical planning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/epi.17482","type":"journal-article","created":{"date-parts":[[2022,12,9]],"date-time":"2022-12-09T08:52:20Z","timestamp":1670575940000},"page":"754-768","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":63,"title":["Spike patterns surrounding sleep and seizures localize the seizure\u2010onset zone in focal epilepsy"],"prefix":"10.1111","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8910-1817","authenticated-orcid":false,"given":"Erin C.","family":"Conrad","sequence":"first","affiliation":[{"name":"Department of Neurology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew Y.","family":"Revell","sequence":"additional","affiliation":[{"name":"Medical Scientist Training Program University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam S.","family":"Greenblatt","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan S.","family":"Gallagher","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2474-1685","authenticated-orcid":false,"given":"Akash R.","family":"Pattnaik","sequence":"additional","affiliation":[{"name":"Department of Bioengineering University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Hartmann","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James J.","family":"Gugger","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell T.","family":"Shinohara","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology, &amp; Informatics University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Penn Statistics in Imaging and Visualization Center University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Center for Biomedical Image Computing and Analytics University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Litt","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric D.","family":"Marsh","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Division of Child Neurology, Pediatric Epilepsy Program Children\u2019s Hospital of Philadelphia  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn A.","family":"Davis","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Pennsylvania  Philadelphia Pennsylvania 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