INTRODUCTION: Accurate localization of the epileptogenic zone is essential for surgical treatment of drug-resistant epilepsy. Standard presurgical evaluations rely on multimodal neuroimaging techniques, but these may be limited by availability and interpretive challenges. This study aimed to assess the concordance between zones identified by ictal semiology and a novel distributed electrical source localization technique, CLARA, and to evaluate their impact on postsurgical outcomes. METHODS: This retrospective study included 16 patients with at least three recorded seizures. Ictal semiology was analyzed subjectively using video electroencephalography (VEEG) by a multidisciplinary team of neurologists, neurophysiologists, and radiologists, who determined the presumed epileptogenic zone at the lobar level. CLARA was subsequently applied to identify the computed zone based on ictal and/or interictal biomarker activities. The concordance between the presumed and computed zones was assessed qualitatively. Postsurgical outcomes were examined in relation to the extent of resection of the CLARA-defined zones. RESULTS: Among thirteen patients with sufficient data for analysis, qualitative comparison showed 77% concordance and 23% partial concordance between the presumed and computed zones. Postsurgical follow-up revealed seizure freedom in one patient with cavernoma following complete resection of the CLARA-defined zone. In contrast, patients with incomplete resection of this region continued to experience seizures. DISCUSSION: The findings support the potential value of CLARA as an adjunctive neuroimaging technique in the presurgical evaluation of epilepsy. By providing an additional layer of verification, CLARA may improve the accuracy of epileptogenic zone localization when used alongside established modalities such as PET, SPECT, fMRI, and MRI. Its adaptability and lower resource requirements suggest particular utility in centers with limited access to advanced medical equipment and specialized personnel. Broader implementation of CLARA could enhance presurgical decision-making and contribute to improved surgical outcomes for epilepsy patients.

Al Witri Hospital for Neurosciences Baghdad Iraq

Computational Neuroergonomics Laboratory Department of Industrial Engineering and Management Systems University of Central Florida Orlando FL United States

Department of Artificial Intelligence Faculty of Information and Communication Technology Wroclaw University of Science and Technology Wroclaw Poland

Department of Biomedical Engineering College of Engineering University of Babylon Babylon Iraq

Department of Clinical Neurophysiology College of Medicine University of Baghdad Baghdad Iraq

Department of Cybernetics and Biomedical Engineering Faculty of Electrical Engineering and Computer Science VSB Technical University of Ostrava Ostrava Czechia

Faculty of Electrical Engineering Automatic Control and Informatics Opole University of Technology Opole Poland

Institute of Computer Science Kazimierz Wielki University in Bydgoszcz Bydgoszcz Poland

Neuropsychological Research Unit 2nd Clinic of the Psychiatry and Psychiatric Rehabilitation Medical University in Lublin Lublin Poland

Citace poskytuje Crossref.org