Integrating artificial intelligence with real-time intracranial EEG monitoring to automate interictal identification of seizure onset zones in focal epilepsy

Yogatheesan Varatharajah, Brent Berry, Jan Cimbalnik, Vaclav Kremen, Jamie Van Gompel, Matt Stead, Benjamin Brinkmann, Ravishankar Iyer, Gregory Worrell

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Objective. An ability to map seizure-generating brain tissue, i.e. the seizure onset zone (SOZ), without recording actual seizures could reduce the duration of invasive EEG monitoring for patients with drug-resistant epilepsy. A widely-adopted practice in the literature is to compare the incidence (events/time) of putative pathological electrophysiological biomarkers associated with epileptic brain tissue with the SOZ determined from spontaneous seizures recorded with intracranial EEG, primarily using a single biomarker. Clinical translation of the previous efforts suffers from their inability to generalize across multiple patients because of (a) the inter-patient variability and (b) the temporal variability in the epileptogenic activity. Approach. Here, we report an artificial intelligence-based approach for combining multiple interictal electrophysiological biomarkers and their temporal characteristics as a way of accounting for the above barriers and show that it can reliably identify seizure onset zones in a study cohort of 82 patients who underwent evaluation for drug-resistant epilepsy. Main results. Our investigation provides evidence that utilizing the complementary information provided by multiple electrophysiological biomarkers and their temporal characteristics can significantly improve the localization potential compared to previously published single-biomarker incidence-based approaches, resulting in an average area under ROC curve (AUC) value of 0.73 in a cohort of 82 patients. Our results also suggest that recording durations between 90 min and 2 h are sufficient to localize SOZs with accuracies that may prove clinically relevant. Significance. The successful validation of our approach on a large cohort of 82 patients warrants future investigation on the feasibility of utilizing intra-operative EEG monitoring and artificial intelligence to localize epileptogenic brain tissue. Broadly, our study demonstrates the use of artificial intelligence coupled with careful feature engineering in augmenting clinical decision making.

Original languageEnglish (US)
Article number046035
JournalJournal of neural engineering
Issue number4
StatePublished - Jun 27 2018


  • artificial intelligence in neurological applications
  • epilepsy surgery
  • high-frequency oscillation
  • interictal epileptiform discharge
  • phase-amplitude coupling
  • seizure onset zone
  • support vector machine

ASJC Scopus subject areas

  • Biomedical Engineering
  • Cellular and Molecular Neuroscience


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