Localization of cerebral epileptiform activity during stereo EEG monitoring

Approximately 1/3 of patients with epilepsy are drug-resistant and should be considered for surgery. Successful epilepsy surgery depends on accurate localization of the seizure onset zone (SOZ), often requiring invasive monitoring with stereoelectroencephalography (sEEG). However, sEEG has inherent spatial limitations, and in many cases, imprecise localization contributes to surgical failure—observed in up to 60% of cases. EEG source localization (ESL) uses mathematical algorithms to localize seizure signals; this is an established technique for scalp EEG but has not been adapted to intracranial EEG. Our supporting data using corticocortical evoked potentials recorded from sEEG suggests that the distributed source algorithm SWARM may have less localization error and be less susceptible to the effects of sensor positioning and source location compared to other algorithms. However, seizure signals typically consist of low voltage high frequency activity, which presents different challenges for source localization and, thus, requires further validation before clinical application. The main goal of this project is to systematically examine the application of ESL techniques to sEEG- recorded seizures. The Specific Aims are: 1) Assess the accuracy and precision of sEEG source localization methods using stimulation-induced seizures.; and 2) Advance sEEG source localization as a predictor for seizure freedom following epilepsy surgery. This research will answer many important questions faced in applying these localization techniques to intracranial- recorded signals and will prepare for a larger prospective trial examining the value of sEEG localization in surgical decision making, utilization of sEEG-ESL for determining the extent of surgical resection, and comparison of sEEG-ESL with non-invasive scalp EEG-ESL and MEG. The applicant has dedicated his career as a clinician and researcher to improving the care of epilepsy patients undergoing surgery. To achieve this, he has begun his career as a tenure- earning Assistant Professor at the University of Alabama at Birmingham, where a supportive collaborative research environment in the Departments of Neurology, Neuroengineering, Neurosurgery, and Pediatric Neurology will make career advancement towards independence possible. To accomplish the goals of this research, the candidate has assembled a mentoring team with decades of experience in clinical trials, EEG/MEG source localization research, statistics, and faculty mentorship to advise and guide him during career development. He also proposes to take formal training in biostatistics, MEG and EEG signal analysis, and clinical trial design to complement his prior training with the skills necessary to transition to independence. Project Number: 1K23NS142570-01A1 | Fiscal Year: 2026 | NIH Institute/Center: National Institute of Neurological Disorders and Stroke (NINDS) | Principal Investigator: Benjamin Cox | Institution: UNIVERSITY OF ALABAMA AT BIRMINGHAM, BIRMINGHAM, AL | Award Amount: $237,870 | Activity Code: K23 | Study Section: Special Emphasis Panel[ZRG1 NINC-Q (01)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11371550