Neural fragility as an EEG marker of the seizure onset zone

Adam Li, Chester Huynh, Zachary Fitzgerald, Iahn Cajigas, Damian Brusko, Jonathan Jagid, Angel O. Claudio, Andres M. Kanner, Jennifer Hopp, Stephanie Chen, Jennifer Haagensen, Emily Johnson, William Anderson, Nathan Crone, Sara Inati, Kareem A. Zaghloul, Juan Bulacio, Jorge Gonzalez-Martinez, Sridevi V. Sarma

Research output: Contribution to journalArticlepeer-review


Over 15 million patients with epilepsy worldwide do not respond to drugs. Successful surgical treatment requires complete removal or disconnection of the seizure onset zone (SOZ), brain region(s) where seizures originate. Unfortunately, surgical success rates vary between 30 and 70% because no clinically validated biological marker of the SOZ exists. We develop and retrospectively validate a new electroencephalogram (EEG) marker—neural fragility—in a retrospective analysis of 91 patients by using neural fragility of the annotated SOZ as a metric to predict surgical outcomes. Fragility predicts 43 out of 47 surgical failures, with an overall prediction accuracy of 76% compared with the accuracy of clinicians at 48% (successful outcomes). In failed outcomes, we identify fragile regions that were untreated. When compared to 20 EEG features proposed as SOZ markers, fragility outperformed in predictive power and interpretability, which suggests neural fragility as an EEG biomarker of the SOZ.

Original languageEnglish (US)
Pages (from-to)1465-1474
Number of pages10
JournalNature Neuroscience
Issue number10
StatePublished - Oct 2021

ASJC Scopus subject areas

  • Neuroscience(all)


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