Connectomics studies the brain as a network of interacting regions rather than isolated anatomical points. In epilepsy surgery, functional and structural connectivity are being investigated as tools for understanding seizure networks, predicting outcome and choosing targets for resection or neuromodulation.
From focus to network
Classic surgical models aimed to identify and remove a discrete epileptogenic focus.
Modern evidence shows that focal epilepsy often involves distributed networks that influence seizure initiation, spread and recovery.
What functional connectivity means
Functional connectivity describes statistical relationships between activity recorded or imaged in different brain regions.
It can be estimated from intracranial EEG, scalp EEG, MEG or functional MRI.
Structural connectivity is different
Structural connectivity describes physical white-matter pathways linking brain regions.
Diffusion MRI tractography is one of the main non-invasive tools used to estimate those pathways.
Why this might help surgery
Network analysis may identify influential hubs, pathways of rapid seizure spread or regions that maintain the epileptic network.
These features could potentially explain why removing a visible lesion sometimes fails and why treating a network node can sometimes reduce seizures.
Neuromodulation is especially network-oriented
Deep brain stimulation and responsive neurostimulation often target or modulate networks rather than removing a single lesion.
The thalamus has received particular attention because of its broad connectivity with cortical seizure networks.
Clinical adoption remains limited
A 2025 review concluded that network models are increasingly associated with surgical outcome but are not yet widely used as routine decision tools.
Differences in methodology, sampling and validation remain major barriers.
Connectomics should complement established evidence
Clinical semiology, MRI, scalp EEG, neuropsychology and invasive monitoring remain the foundation of presurgical evaluation.
Connectomics is best understood as an additional layer of information rather than a replacement for those methods.
Related reading
Sources and further reading
- Can brain network analyses guide epilepsy surgery?
- Imaging and SEEG functional networks to guide epilepsy surgery
- EEG-derived connectivity informing surgical planning
Evidence checked: September 2026.