Computational neuroelectrophysiology and artificial intelligence for drug-resistant epilepsy: recent advances, current challenges, and future directions

Drug-resistant epilepsy (DRE) affects approximately 30% of epilepsy patients, with surgical cure rates below 70%. This challenge drives a fundamental paradigm shift from localizing a discrete epileptogenic zone toward characterizing and modulating the dysfunctional brain networks that initiate and propagate seizures. This review critically synthesizes how computational neuroelectrophysiology and artificial intelligence (AI) converge to propel this shift. We chart the trajectory from quantifying local biomarkers, including high-frequency oscillations and excitation–inhibition balance metrics, to mapping the topological properties of epileptic networks through functional and effective connectivity. The integration of these network features with AI techniques, particularly spatiotemporal deep learning architectures, has demonstrated significant potential for enhancing both the localization of the epileptogenic network and the prediction of postoperative outcomes. However, the translation of this network-centric paradigm into clinical practice remains constrained by several challenges, including spatial sampling bias, the inherent label instability of surgical outcomes, and the ‘black-box’ interpretability crisis. Future directions must emphasize EEG foundation models, causal AI, and the development of interactive multimodal AI agents. The convergence of mechanism-driven network models and data-driven AI frameworks promises a new era of personalized, network-guided therapy for DRE.