Interictal functional ultrasound imaging in human epilepsy resection and responsive neurostimulation surgery
Authors: K. A. Agyeman, D. Lee, B. P. Lee, R. J. McGinn, A. Abedi, J. Russin, K. Wu, w. Choi, C. Liu, V. N. Christopoulos
Abstract
Over 30% of patients with epilepsy are refractory to medication and may require surgical or neuromodulation-based intervention. Accurate localization of seizure-onset zones (SOZ) and assessment of treatment-associated brain responses remain major clinical challenges. Current workflows may involve invasive intracranial monitoring, prolonged hospitalization, adjustment of anti-seizure medications, and seizure capture to localize the SOZ, while opportunities for complementary intraoperative functional assessment remain limited. We used intraoperative functional ultrasound imaging (fUSI) to characterize interictal (i.e., non-seizure) cortical activity in nine patients with drug-resistant focal epilepsy and to assess treatment-associated brain responses following SOZ resection and responsive neurostimulation (RNS). fUSI signals were acquired directly from the exposed cortex during standard-of-care surgery. We developed six ultrafast power Doppler-based interictal activity markers (IaMs) to distinguish SOZ from peri-resection zone (PRZ) cortex and to quantify treatment-associated changes. The IaMs revealed distinct interictal hemodynamic dynamics between SOZ and PRZ cortex. Following SOZ resection, all six markers changed significantly within the surrounding PRZ. RNS also induced robust, stimulation paradigm-dependent modulation of cortical hemodynamic dynamics. Notably, RNS and surgical resection produced concordant directional changes across five of the six IaMs, despite representing fundamentally different therapeutic interventions. Together, these findings demonstrate the feasibility of intraoperative fUSI for characterizing and distinguishing interictal dynamics within SOZ and PRZ cortex and assessing treatment-associated cortical responses during human epilepsy surgery. Furthermore, fUSI could provide a complementary high-resolution functional imaging approach alongside established clinical methods for SOZ localization and intraoperative functional assessment.
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Spatio-temporal characterization of causal electrophysiological activity stimulated by single pulse focused ultrasound: An ex vivo study on hippocampal brain slicesIvan Suarez-Castellanos, Elena Dossi, Jeremy Vion-Bailly et al. · 2021 · Classical Physics · cited 19 times · Not summarized yet
Abstract
Objective: The brain operates via generation, transmission and integration of neuronal signals and most neurological disorders are related to perturbation of these processes. Neurostimulation by Focused Ultrasound (FUS) is a promising technology with potential to rival other clinically-used techniques for the investigation of brain function and treatment of numerous neurological diseases. The purpose of this study was to characterize spatial and temporal aspects of causal electrophysiological signals directly stimulated by short, single pulses of focused ultrasound (FUS) on ex vivo mouse hippocampal brain slices. Approach: MicroElectrode Arrays (MEA) are used to study the spatio-temporal dyn…
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Intraoperative Very High-Frequency Activity for Localization of the Epileptogenic Zone: An International Multicenter StudyH. Uda, N. Kuroda, N. Usui et al. · 2026 · medRxiv · preprint, not peer reviewed · Not summarized yet
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Contribution of ictal-interictal SPECT and SISCOM to preoperative localization of the epileptogenic zone in frontal lobe epilepsyL. Wichert-Ana, Ricardo Fernandes Amaral, J. Fernandes et al. · 2026 · Radiologia Brasileira · Not summarized yet
Abstract
Objective To describe the contributions of conventional single-photon emission computed tomography (SPECT) and subtraction ictal-interictal SPECT coregistered to magnetic resonance imaging (SISCOM) for the preoperative identification of the epileptogenic zone (EZ) in patients with frontal lobe epilepsy (FLE). Materials and methods In this retrospective study, we reviewed medical records of all patients with refractory FLE who underwent frontal lobectomy at our institution between 2015 and 2020, all of whom had undergone at least one ictal SPECT, one interictal SPECT, one high-resolution magnetic resonance imaging examination, SISCOM, and at least one year of follow-up. Fourteen patients met …
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fNIRS-VFT is a complementary tool to 18F-FDG PET in presurgical evaluation of drug-resistant epilepsy: an exploratory studyShu-Ting Hong, Hui-Qin Xiao, Cheng-Jun Li et al. · 2026 · Acta Epileptologica · Not summarized yet
Abstract
Accurate presurgical localization of the epileptogenic zone (EZ) and preservation of postoperative cognitive function are two critical but often competing goals in epilepsy surgery for drug-resistant epilepsy (DRE). This study aimed to (1) evaluate the complementary value of functional near-infrared spectroscopy during a verbal fluency task (fNIRS-VFT) alongside interictal 18F-FDG PET for presurgical EZ localization; and (2) explore whether task-based fNIRS functional connectivity is associated with postoperative verbal memory decline. We retrospectively included patients with DRE who underwent epilepsy surgery between December 2022 and December 2023 and completed both interictal PET and fNI…
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Multimodal neuroimaging fusion in presurgical evaluation of drug-resistant epilepsy: current evidence, clinical integration, and future directionsYu-Ying Zhao, Mingli Wang, Bo Shen et al. · 2026 · Frontiers in Neuroscience · Not summarized yet
Abstract
Approximately 30% of patients with epilepsy are drug-resistant, and for many of them surgical resection of the epileptogenic zone (EZ) offers the best chance of seizure freedom. Because the EZ cannot be measured directly by any single test, it must be inferred from the convergence of complementary imaging markers, and multimodal neuroimaging fusion has therefore become central to modern presurgical evaluation. This critical narrative review examines what each modality—structural MRI, [18F]FDG-PET, ictal SPECT/SISCOM, magnetoencephalography and electric source imaging, functional MRI, diffusion tensor imaging, and arterial spin labeling—contributes as a surrogate marker of the epileptic netwo…
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Combining responsive neurostimulation with resection or ablation for treatment of epilepsy: a multicenter experience.Christian G. Lopez Ramos, A. Raslan, Vikram R. Rao et al. · 2026 · Journal of Neurosurgery · Not summarized yet
Abstract
OBJECTIVE Despite advances in surgical and neuromodulatory treatments, a substantial proportion of patients with drug-resistant epilepsy remain ineligible for standalone resection or ablation. Combining resection or laser interstitial thermal therapy (LITT) with responsive neurostimulation (RNS) has emerged as a promising approach for patients with multifocal seizure onset or eloquent cortex involvement. However, the clinical impact of combination surgery remains poorly characterized. The aim of this study was to characterize the clinical rationale and surgical decision-making used across multiple high-volume epilepsy centers performing combination surgeries, and to evaluate the seizure outc…
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Non-invasive preoperative prediction of surgical outcomes in drug-resistant epilepsy using seizure-related EEG network dynamicsR. Feng, Q. Luo, Dan-Ni Yang et al. · 2026 · Frontiers in Neuroscience · Not summarized yet
Abstract
Stereoelectroencephalography (SEEG)-guided radiofrequency thermocoagulation (RF-TC) has emerged as a minimally invasive treatment option for selected patients with drug-resistant epilepsy (DRE). However, its overall therapeutic efficacy remains suboptimal, with seizure-free rates typically falling below 70%. To facilitate precision management of DRE and reduce the potential risk of ineffective or high-risk surgical interventions, a reliable, robust, and non-invasive preoperative evaluation framework for accurately predicting postoperative surgical outcomes is critically needed. This study proposes a novel non-invasive computational framework based on EEG source imaging for preoperative outco…
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Intraoperative neurophysiology monitoring in pediatric epilepsy surgery: a case series from a tertiary Italian center.Edoardo Fino, Barbara Bettino, Federico Melani et al. · 2026 · Neurophysiologie clinique · Not summarized yet
Abstract
OBJECTIVES To characterize intraoperative neurophysiological monitoring in pediatric epilepsy surgery in a single tertiary center. METHODS We reviewed intraoperative neurophysiological monitoring procedures during pediatric epilepsy surgeries at Meyer Children's Hospital, Florence, Italy, from 2018 to 2025. RESULTS We analyzed 39 procedures in 37 children with lesional epilepsy. Mean age at surgery was 9.4 years. All patients underwent a comprehensive presurgical workup. Frontal lobe resection was the most frequent surgery, and focal cortical dysplasia was the most common histopathology. Total intravenous anesthesia and neuronavigation were used routinely. Brain activity was monitored using …
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