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An ability to map seizure-generating brain tissue, i.e., the seizure onsetzone (SOZ), without recording actual seizures could reduce the duration ofinvasive EEG monitoring for patients with drug-resistant epilepsy. Awidely-adopted practice in the literature is to compare the incidence(events/time) of putative pathological electrophysiological biomarkersassociated with epileptic brain tissue with the SOZ determined from spontaneousseizures recorded with intracranial EEG, primarily using a single biomarker.Clinical translation of the previous efforts suffers from their inability togeneralize across multiple patients because of (a) the inter-patientvariability and (b) the temporal variability in the epileptogenic activity.Here, we report an artificial intelligence-based approach for combiningmultiple interictal electrophysiological biomarkers and their temporalcharacteristics as a way of accounting for the above barriers and show that itcan reliably identify seizure onset zones in a study cohort of 82 patients whounderwent evaluation for drug-resistant epilepsy. Our investigation providesevidence that utilizing the complementary information provided by multipleelectrophysiological biomarkers and their temporal characteristics cansignificantly improve the localization potential compared to previouslypublished single-biomarker incidence-based approaches, resulting in an averagearea under ROC curve (AUC) value of 0.73 in a cohort of 82 patients. Ourresults also suggest that recording durations between ninety minutes and twohours are sufficient to localize SOZs with accuracies that may prove clinicallyrelevant. The successful validation of our approach on a large cohort of 82patients warrants future investigation on the feasibility of utilizingintra-operative EEG monitoring and artificial intelligence to localizeepileptogenic brain tissue.

journal of neural engineering

Integrating Artificial Intelligence with Real-time Intracranial EEG  Monitoring to Automate Interictal Identification of Seizure Onset Zones in  Focal Epilepsy