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We studied the relationship between ASM load and two electroencephalography (EEG) markers of cortical excitability in people with refractory epilepsy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We included individuals with refractory focal epilepsy undergoing presurgical evaluation, involving ASM tapering and sleep deprivation. We obtained daily resting state EEG and EEG responses to visual stimulation at linearly increasing flash frequency (10\u201340\u2009Hz chirp). We extracted the aperiodic exponent from resting state EEG power spectra and analysed chirp response at driving and second\u2010order harmonic frequencies. We modelled ASM load, which we related to the EEG markers using linear mixed\u2010effects regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty\u2010eight subjects (median age 34\u2009years, age range 16\u201362\u2009years, 19 females) participated. The spectral exponent became less negative with ASM load reduction (<jats:italic>p<\/jats:italic>\u2009=\u20090.02), mainly attributable to reduced low\u2010frequency power. Lowering ASM load increased the harmonic response to chirp stimulation (<jats:italic>p<\/jats:italic>\u2009=\u20090.004), also after accounting for sleep deprivation (<jats:italic>p<\/jats:italic>\u2009=\u20090.02), but did not affect the driving response. ASM tapering specifically increased harmonic responses to high stimulation frequencies (27\u201340\u2009Hz, <jats:italic>p<\/jats:italic>\u2009=\u20090.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>Resting state EEG spectral exponents and visual chirp responses reflect ASM load in refractory epilepsy. Low\u2010frequency spectral changes in resting state EEG may only mirror ASM\u2010induced spectral slowing. Visual chirp stimulation reveals enhanced harmonic EEG responses during low ASM loads, likely due to both increased high gamma activity and increased response to visual perturbations. Implementation of the markers would need normative values to reduce the delay to individually optimised treatment regimens.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acn3.70045","type":"journal-article","created":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T09:44:11Z","timestamp":1745228651000},"page":"1265-1275","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["<scp>EEG<\/scp> Spectral Exponents and Visual Chirp Responses Mirror Anti\u2010Seizure Medication Load in Refractory Focal Epilepsy"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0881-9315","authenticated-orcid":false,"given":"Silvano R.","family":"Gefferie","sequence":"first","affiliation":[{"name":"Stichting Epilepsie Instellingen Nederland (SEIN)  Heemstede the Netherlands"},{"name":"Department of Neurology Leiden University Medical Centre  Leiden the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8375-5975","authenticated-orcid":false,"given":"Arthur R.","family":"van Nieuw Amerongen","sequence":"additional","affiliation":[{"name":"Stichting Epilepsie Instellingen Nederland (SEIN)  Heemstede the Netherlands"},{"name":"Department of Neurology Leiden University Medical Centre  Leiden the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6708-6396","authenticated-orcid":false,"given":"Gerhard H.","family":"Visser","sequence":"additional","affiliation":[{"name":"Stichting Epilepsie Instellingen Nederland (SEIN)  Heemstede the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1258-5678","authenticated-orcid":false,"given":"Maeike","family":"Zijlmans","sequence":"additional","affiliation":[{"name":"Stichting Epilepsie Instellingen Nederland (SEIN)  Heemstede the Netherlands"},{"name":"Department of Neurology University Medical Center Utrecht  Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6501-9971","authenticated-orcid":false,"given":"Else A.","family":"Tolner","sequence":"additional","affiliation":[{"name":"Department of Neurology Leiden University Medical Centre  Leiden the Netherlands"},{"name":"Department of Human Genetics Leiden University Medical Centre  Leiden the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3806-2031","authenticated-orcid":false,"given":"Mark","family":"van de Ruit","sequence":"additional","affiliation":[{"name":"Department of Neurology Leiden University Medical Centre  Leiden the Netherlands"},{"name":"Department of Biomechanical Engineering Delft University of Technology  Delft the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9310-5535","authenticated-orcid":false,"given":"Arn M. 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