Commentary - (2025) Volume 11, Issue 3
Received: 01-Jun-2025, Manuscript No. elj-25-173009;
Editor assigned: 03-Jun-2025, Pre QC No. P-173009;
Reviewed: 17-Jun-2025, QC No. Q-173009;
Revised: 23-Jun-2025, Manuscript No. R-173009;
Published:
30-Jun-2025
, DOI: 10.37421/2472-0895.2025.11.324
Citation: Murphy, Aoife. "Drug-Resistant Epilepsy: Localization and Treatment Advances." Epilepsy J 11 (2025):324.
Copyright: © 2025 Murphy A. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Addressing drug-resistant epilepsy often requires precise identification and targeting of the epileptogenic zone to achieve seizure freedom. Stereoelectroencephalography-guided radiofrequency thermocoagulation shows promise for treating epilepsy, synthesizing evidence across studies to highlight its role in precisely ablating epileptogenic tissue, especially when resection is not feasible or has failed. This approach aims to improve patient outcomes by precisely destroying the identified epileptogenic zone[1].
High-frequency oscillations (HFOs) are emerging as potential biomarkers for pinpointing the epileptogenic zone. This critical review examines the challenges and advancements in utilizing HFOs recorded from intracranial EEG, assessing their sensitivity and specificity in localizing seizure onset. Researchers are exploring different HFO types, their underlying mechanisms, and how they might refine surgical strategies for drug-resistant epilepsy[2].
Positron Emission Tomography (PET) is integral to the presurgical evaluation of epilepsy. This update details how various PET tracers, particularly [18F]FDG, assist in localizing the epileptogenic zone by identifying areas of hypometabolism. The discussion includes advancements in PET imaging, its integration with MRI and other modalities, and its critical role in guiding resective surgery, especially in MRI-negative cases[3].
Connectivity analysis offers a contemporary perspective on defining the epileptogenic zone, acknowledging epilepsy as a network disorder rather than merely a focal lesion. This review discusses diverse connectivity measures derived from EEG, MEG, and fMRI, illustrating how altered functional and structural connections can reveal the core of the epileptic network, thereby guiding more effective surgical approaches[4].
Neuroimaging, in its multifaceted role, is crucial for evaluating drug-resistant epilepsy presurgically. This article covers structural MRI and advanced functional imaging like PET and SPECT, highlighting their utility in localizing the epileptogenic zone. These techniques, frequently used in combination, help identify subtle lesions or functional abnormalities that inform surgical planning, promoting personalized strategies for seizure freedom[5].
The application of machine learning techniques for localizing the epileptogenic zone is gaining traction. This systematic review summarizes studies leveraging various EEG features, including HFOs and connectivity patterns, as input for machine learning algorithms. These automated methods hold significant potential for improving the accuracy and efficiency of presurgical evaluation, promising more reliable identification of the seizure onset zone[6].
Presurgical evaluation in pediatric epilepsy presents distinct challenges due to ongoing brain development and varied etiologies. This paper details the unique aspects of identifying the epileptogenic zone in children, outlining a comprehensive diagnostic workup that includes imaging, EEG, and neuropsychological assessments. It emphasizes the necessity of a multidisciplinary approach to achieve successful surgical outcomes and enhance young patients' quality of life[7].
Deep learning is also being explored for delineating the epileptogenic zone from stereo-electroencephalography (sEEG) data. This research showcases how complex neural networks can process large volumes of sEEG signals to pinpoint subtle patterns indicative of seizure onset and propagation, potentially leading to more precise localization. The aim is to improve diagnostic accuracy and surgical targeting for drug-resistant epilepsy patients, moving beyond conventional visual inspection methods[8].
A systematic review and meta-analysis of studies from the last decade provides insights into the long-term outcomes of resective epilepsy surgery. It synthesizes data on seizure freedom rates, cognitive impacts, and quality of life following the surgical removal of the epileptogenic zone. This paper underscores the critical role of accurate presurgical localization in achieving sustained seizure control and positive long-term results[9].
Understanding the intersection of focal cortical dysplasia (FCD) and genetic epilepsies is vital for clinical-pathological correlations and prognostic implications, particularly concerning the epileptogenic zone. This article discusses how genetic factors can predispose individuals to FCD, a frequent cause of drug-resistant focal epilepsy. Identifying these links is fundamental for uncovering the underlying epileptogenic substrate, which guides therapeutic strategies, including surgical interventions, to improve patient outcomes[10].
The ongoing challenge of drug-resistant epilepsy necessitates precise localization and targeted intervention to achieve seizure freedom. Stereoelectroencephalography-guided radiofrequency thermocoagulation is a notable advancement, effective for ablating epileptogenic tissue, particularly where resection is not feasible or has failed. Its focus is on achieving seizure freedom and improving patient outcomes by precisely destroying the identified epileptogenic zone[1]. Such targeted destruction of the identified epileptogenic zone exemplifies a crucial shift towards less invasive yet highly effective treatment modalities. The ultimate goal is always to maximize the chance of seizure freedom while minimizing neurological deficits.
High-frequency oscillations (HFOs) are critically reviewed as potential biomarkers for pinpointing the epileptogenic zone. This discussion highlights the challenges and advancements in utilizing HFOs recorded from intracranial EEG, weighing their sensitivity and specificity in localizing seizure onset, and exploring their underlying mechanisms to refine surgical strategies for drug-resistant epilepsy[2]. Furthermore, deep learning is being explored to delineate the epileptogenic zone from stereo-electroencephalography (sEEG) data. Complex neural networks process vast sEEG signals to identify subtle patterns indicative of seizure onset and propagation, aiming to improve diagnostic accuracy and surgical targeting for drug-resistant epilepsy patients beyond traditional visual inspection[8].
Neuroimaging plays an evolving and crucial role in presurgical evaluation. Positron Emission Tomography (PET) offers an update on its use, emphasizing how different tracers, particularly [18F]FDG, help localize the epileptogenic zone by identifying hypometabolism. The discussion covers advancements in PET imaging, its integration with MRI and other modalities, and its critical role in guiding resective surgery, especially in MRI-negative cases[3]. A broader review of neuroimaging covers structural MRI and advanced functional imaging like PET and SPECT, highlighting their utility in localizing the epileptogenic zone. These techniques, often combined, help identify subtle lesions or functional abnormalities that guide surgical planning, emphasizing personalized approaches to achieve seizure freedom[5]. The understanding of epilepsy as a network disorder has led to connectivity analysis for delineating the epileptogenic zone. This approach uses various connectivity measures from EEG, MEG, and fMRI to reveal altered functional and structural connections, pinpointing the core epileptic network and guiding more effective surgical strategies[4].
Machine learning techniques are systematically reviewed for epileptogenic zone localization, summarizing studies that leverage diverse EEG features, including high-frequency oscillations and connectivity patterns. These automated methods hold significant potential to improve the accuracy and efficiency of presurgical evaluation, offering a promising avenue for more reliably identifying the seizure onset zone[6]. Presurgical evaluation for pediatric epilepsy has unique aspects, presenting specific challenges due to ongoing brain development and varied etiologies. The comprehensive diagnostic workup, involving imaging, EEG, and neuropsychological assessments, underscores the multidisciplinary approach needed to achieve successful surgical outcomes and improve quality of life for young patients[7]. The intersection of focal cortical dysplasia (FCD) and genetic epilepsies is explored, focusing on their clinical-pathological correlations and prognostic implications regarding the epileptogenic zone. Understanding how genetic factors predispose individuals to FCD is crucial for identifying the underlying epileptogenic substrate, which guides therapeutic strategies, including surgical interventions, to improve patient outcomes[10].
Finally, assessing the long-term outcomes of resective epilepsy surgery is crucial. A systematic review and meta-analysis of studies published in the last decade synthesizes data on seizure freedom rates, cognitive impacts, and quality of life after surgical removal of the epileptogenic zone. This research highlights factors associated with successful outcomes, emphasizing the critical role of accurate presurgical localization in achieving sustained seizure control[9].
Research into drug-resistant epilepsy continues to advance, with significant focus on precisely localizing the epileptogenic zone to improve surgical outcomes. Recent studies highlight the effectiveness of stereoelectroencephalography-guided radiofrequency thermocoagulation for ablating epileptogenic tissue, particularly when traditional resection is challenging or has failed. High-frequency oscillations recorded from intracranial EEG are emerging as crucial biomarkers for pinpointing seizure onset, though their precise role and interpretation still pose challenges. Neuroimaging techniques, including Positron Emission Tomography, particularly with [18F]FDG, play a vital role in presurgical evaluation by identifying hypometabolic areas, often integrated with MRI, especially in cases where structural abnormalities are not evident. The understanding of epilepsy has shifted, now often viewed as a network disorder, prompting the use of connectivity analysis from EEG, MEG, and fMRI to uncover the core epileptic network. Machine learning and deep learning algorithms are revolutionizing this field, processing complex EEG and sEEG data to automate and enhance the accuracy of epileptogenic zone localization, moving beyond subjective visual inspection. The presurgical evaluation of pediatric epilepsy presents unique challenges due to developmental factors, necessitating a comprehensive, multidisciplinary diagnostic approach. Long-term outcomes of resective epilepsy surgery confirm the importance of accurate presurgical localization for sustained seizure control and improved quality of life. Furthermore, understanding the interplay between focal cortical dysplasia and genetic epilepsies is crucial for identifying underlying epileptogenic substrates and guiding tailored therapeutic strategies.
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