Multimodal Imaging Epilepsy Surgery: What the Review Shows

What was studied

This was a critical narrative review of research on combining several brain-imaging methods before surgery for drug-resistant epilepsy. It did not enroll a new group of patients or test one specific treatment.

The review covered structural MRI, FDG-PET, ictal SPECT/SISCOM, MEG and electrical source imaging, functional MRI, diffusion tensor imaging, and arterial spin labeling. It examined their use in situations such as MRI-negative and extratemporal epilepsy, suspected focal cortical dysplasia, discordant non-invasive results, and planning for stereo-EEG.

What they found

No single test can directly identify the epileptogenic zone—the brain area that would need to be treated to achieve seizure freedom. Combining information from complementary imaging methods may increase confidence in localization and help teams plan further evaluation or surgery.

The review emphasizes that improved localization confidence does not necessarily improve seizure freedom. Network-based methods and personalized computer models are conceptually promising but remain largely investigational, while reported machine-learning performance still requires broader validation. Multimodal imaging supports rather than replaces evaluation by an expert multidisciplinary epilepsy team.

Limits of the evidence

This was a narrative review, not a prospective clinical trial. Much of the available evidence comes from retrospective, single-center, or internally validated studies. Reported performance may therefore represent an upper bound rather than accuracy that can be expected across different centers.

The abstract does not provide the number, ages, or other characteristics of patients included across the reviewed studies. It also does not establish that any particular imaging combination improves seizure freedom compared with standard evaluation.

For families and caregivers

For families considering epilepsy surgery, combining scans may help the clinical team interpret complex or conflicting findings, including when a standard MRI does not show a clear abnormality. However, improved confidence about localization does not guarantee seizure freedom. Imaging should be interpreted alongside the broader expert multidisciplinary evaluation rather than used on its own.

What to watch next

Stronger evidence would come from prospective studies across multiple centers, with standardized imaging workflows and assessment of whether these approaches improve clinically important outcomes such as seizure freedom.

Terms in this summary

drug-resistant epilepsy

Epilepsy that continues despite treatment with anti-seizure medicines.

epileptogenic zone

The brain area that would need to be removed or otherwise treated to achieve seizure freedom.

multimodal neuroimaging fusion

Combining information from different brain scans or brain-activity tests into one analysis.

MRI-negative epilepsy

Epilepsy in which a standard MRI does not show a clear structural abnormality explaining the seizures.

focal cortical dysplasia

An area of abnormal development in the brain’s cortex that may be associated with seizures and can be difficult to identify on routine MRI.

SISCOM

A method that compares SPECT scans obtained during and between seizures and displays the difference on MRI.

stereo-EEG

A procedure using electrodes placed within the brain to help identify seizure-related areas.

retrospective study

A study that analyzes information already collected rather than following a planned protocol forward in time.