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Title: Resting-State Functional MRI Connectivity for Presurgical Planning in Drug-Resistant Epilepsy: A Systematic Review and Clinical Translation Framework
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1
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| Subject:
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Brain Mapping Applications in Epilepsy – Across Pediatric and Adult Populations
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Presenter Author:
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Zeinab Sinaeifar
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Author:
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| Name 1:
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Zeinab Sinaeifar - Corresponding - Presenter
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maternal-fetal and neonatal research center, family health institute, imam khmeini hospital, tehran university of medical sciences, tehran, iran
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Mohammad Azizi
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maternal-fetal and neonatal research center, family health institute, imam khmeini hospital, tehran university of medical sciences, tehran, iran
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Sara Mehri
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maternal-fetal and neonatal research center, family health institute, imam khmeini hospital, tehran university of medical sciences, tehran, iran
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Abstract
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Original Research
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introduction :
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To evaluate whether resting-state functional MRI (rs-fMRI) connectivity can localize the seizure onset zone (SOZ) for presurgical planning in drug-resistant epilepsy (DRE) compared with established SOZ-localizing modalities, and to propose a pragmatic framework for clinical translation.
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Methods:
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We conducted a PRISMA-guided systematic review of PubMed/MEDLINE, Embase, Scopus, Web of Science, and Google Scholar (April 2010–April 2020). Eligible studies included pediatric or adult DRE cohorts in which rs-fMRI–derived SOZ/epileptogenic localization was compared with established comparators (e.g., scalp electroencephalography [EEG], intracranial EEG [iEEG], anatomical MRI, EEG-fMRI, magnetoencephalography) and/or surgical outcomes. Agreement between rs-fMRI localization and comparator modalities was summarized using odds ratios (ORs). Fixed- and random-effects models were used to quantify heterogeneity and to test whether agreement differed systematically across comparator modalities and across studies within the same modality.
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Results:
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Among 14,384 records identified, 9,550 non-duplicate records were screened and 25 studies met inclusion criteria. Comparator modalities included scalp EEG (n=7), surgical outcome (n=6), iEEG (n=5), anatomical MRI (n=4), EEG-fMRI (n=2), and magnetoencephalography (n=1). The most frequently used rs-fMRI approaches were independent component analysis (n=9) and seed-based connectivity (n=8). Study-level agreement ORs demonstrated substantial heterogeneity in both fixed- and random-effects analyses (p<0.001). Agreement differed across comparator modalities (p=0.005) and also across studies using the same comparator (p=0.002), consistent with variability in acquisition, preprocessing/denoising, localization definitions, and reference standards. Agreement between rs-fMRI localization and SOZ was higher when surgical outcome was the reference compared with EEG (p=0.002) or iEEG (p=0.007). The estimated population mean sensitivity and specificity for rs-fMRI SOZ localization were 0.91 and 0.09, respectively, with wide predicted ranges across studies (0.44–0.96 for sensitivity; 0.02–0.67 for specificity).
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Conclusion:
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rs-fMRI connectivity demonstrates high sensitivity but low and variable specificity for SOZ localization across heterogeneous studies, likely reflecting methodological variability and non-equivalence of comparator “ground truth” standards. For translation into presurgical workflows, we propose a stepwise framework emphasizing: (1) minimum acquisition and quality-control criteria (including motion thresholds), (2) standardized preprocessing/denoising and transparent reporting, (3) prespecified localization outputs with uncertainty estimates, (4) structured integration alongside MRI/EEG/iEEG in multidisciplinary surgical conferences, and (5) outcome-linked validation with multicenter benchmarking to support reproducible deployment.
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| Attachment:
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| Keywords:
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Drug-resistant epilepsy (DRE); resting-state fMRI (rs-fMRI); functional connectivity; seizure onset zone (SOZ) localization; presurgical evaluation; epilepsy surgery planning; clinical translation.
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| Key message:
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