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Despite numerous studies exploring its utility, the added value of iEEG connectivity over standard clinical presurgical evaluation remains unclear. We assess the current evidence on the efficacy of iEEG connectivity analyses to improve seizure outcomes following epilepsy surgery through a systematic review and meta\u2010analysis. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta\u2010Analyses) reporting guidelines, we searched PubMed and Embase for studies (2006\u20132024) of adult focal drug\u2010resistant epilepsy patients who underwent surgical resection or ablation, reported outcomes at least 1 year postsurgery, and used iEEG connectivity analysis to localize networks. Reviews, nonhuman studies, and studies lacking iEEG connectivity analysis or network localization were excluded. We derived classification metrics (true\/false positives\/negatives) based on concordance between iEEG findings, clinical localization, and outcome. Subgroup meta\u2010analyses and meta\u2010regressions determined differences by seizure type, lesion status, and analysis approach. Of 2881 studies screened, 25 met criteria (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009909). The pooled odds ratio comparing seizure outcome prediction using iEEG connectivity versus standard clinical evaluation was 1.36 (95% confidence interval\u2009=\u20091.10\u20131.69,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u2009.004), indicating a significant overall benefit. Subgroup analyses found no significant differences by directionality, modeling method (linear\/nonlinear), or iEEG epoch (interictal\/peri\u2010ictal). Meta\u2010regression revealed greater added value of iEEG connectivity in studies with higher proportions of non\u2010seizure\u2010free patients following surgery for temporal lobe or lesional epilepsy. However, no individual study achieved statistical significance on its own, reflecting limited power and lack of individual patient\u2010level data. Power analysis confirmed that detecting a clinically meaningful effect requires substantially larger, potentially multicenter datasets. iEEG connectivity analysis offers modest but consistent increased value over standard clinical methods to predict seizure freedom in adult patients with focal drug\u2010resistant epilepsy. For clinical translation, we propose recommendations for future studies to address sample size limitations, standardize reporting, and prioritize individual patient\u2010level data sharing.\n                  <\/jats:p>","DOI":"10.1002\/epi.70168","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T17:00:21Z","timestamp":1772989221000},"page":"2707-2724","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Intracranial electroencephalographic connectivity analysis to localize epileptogenic networks: Systematic review and meta\u2010analysis from\n                    <scp>ILAE<\/scp>\n                    Epilepsy Surgery Networks Task Force"],"prefix":"10.1002","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2090-4889","authenticated-orcid":false,"given":"Nishant","family":"Sinha","sequence":"first","affiliation":[{"name":"Department of Biostatistics, Epidemiology, and Informatics University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Department of Neurology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0154-8348","authenticated-orcid":false,"given":"Daniel J.","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8263-2324","authenticated-orcid":false,"given":"Victoria L.","family":"Morgan","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering Vanderbilt University Medical Center  Nashville Tennessee USA"},{"name":"Department of Neurological Surgery Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8373-690X","authenticated-orcid":false,"given":"Dario J.","family":"Englot","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering Vanderbilt University Medical Center  Nashville Tennessee USA"},{"name":"Department of Neurological Surgery Vanderbilt University Medical Center  Nashville Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6153-8942","authenticated-orcid":false,"given":"Leonardo","family":"Bonilha","sequence":"additional","affiliation":[{"name":"Department of Neurology University of South Carolina  Columbia South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7979-2343","authenticated-orcid":false,"given":"Milan","family":"Br\u00e1zdil","sequence":"additional","affiliation":[{"name":"Brno Epilepsy Center, First Department of Neurology, St. Anne's University Hospital and School of Medicine Masaryk University  Brno Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7941-2918","authenticated-orcid":false,"given":"Xiaosong","family":"He","sequence":"additional","affiliation":[{"name":"Department of Psychology University of Science and Technology of China  Hefei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3985-9210","authenticated-orcid":false,"given":"Riki","family":"Masumoto","sequence":"additional","affiliation":[{"name":"Department of Neurology Kyoto University  Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6204-1305","authenticated-orcid":false,"given":"Quy","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology, and Informatics University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7198-8621","authenticated-orcid":false,"given":"Terence J.","family":"O'Brien","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, School of Translational Medicine, Alfred Health and Monash University  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3954-2929","authenticated-orcid":false,"given":"Chengyuan","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Thomas Jefferson University  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3252-5365","authenticated-orcid":false,"given":"Erik","family":"Kaestner","sequence":"additional","affiliation":[{"name":"Departments of Radiation Medicine &amp; Applied Sciences and Psychiatry University of California, San Diego  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XuZ ShiH OrzechowskiP SpenceJ DavisKA et\u00a0al.Pennsieve: a collaborative platform for translational neuroscience and 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