{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T17:38:09Z","timestamp":1786469889108,"version":"build-2736575974"},"reference-count":48,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Subclinical seizures (SCSs) remain an understudied aspect of presurgical evaluation in patients with drug\u2010resistant epilepsy (DRE), with uncertain prevalence, distribution among epilepsy types, and predictive value for surgical outcomes. This systematic review and meta\u2010analysis aims to explore the occurrence of SCSs, their concordance with the seizure\u2010onset zone (SOZ), and their association with postoperative seizure outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search of Medline, Embase, and Web of Science was performed to identify studies reporting SCSs during scalp electroencephalography (EEG) monitoring or intracranial EEG (iEEG) monitoring in patients with DRE undergoing epilepsy surgery. Data on SCS prevalence, concordance with SOZ, and postoperative outcomes were extracted. Pooled proportions and odds ratios (ORs) were estimated using random\u2010effects generalized linear mixed models. Subgroup analyses evaluated the proportions of SCSs in temporal vs extratemporal epilepsy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Thirteen studies comprising 1174 patients met the inclusion criteria. The pooled prevalence of SCSs was 32% (95% confidence interval [CI] 8\u201373) during scalp EEG monitoring and 50% (95% CI 38\u201362) during iEEG monitoring. Concordant SCSs with SOZ occurred in 37% of patients undergoing iEEG. Non\u2010concordant SCSs were associated with a nearly fivefold higher odds of poor postoperative seizure control (OR 4.82, 95% CI 1.80\u201312.96;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). SCSs were more frequent in temporal lobe epilepsy than in extratemporal epilepsy (57% vs 44%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.046). Within temporal lobe epilepsy, the highest prevalence was observed in the mesiotemporal region (69%). Overall, the presence of SCSs alone was not associated with a poor outcome, but the spatial non\u2010concordance with the SOZ was highly predictive for poor seizure outcome.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>SCSs are common in presurgical evaluation, particularly in temporal lobe epilepsy. Although their presence alone is not prognostic, non\u2010concordant SCSs are associated with worse postoperative outcomes. Systematic assessment, especially using iEEG, may improve delineation of the epileptogenic zone and surgical planning in DRE.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/epi.70417","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T16:50:41Z","timestamp":1786467041000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical significance of subclinical seizures in epilepsy presurgical evaluation: A systematic review and meta\u2010analysis"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0488-7863","authenticated-orcid":false,"given":"Pilar","family":"Bosque\u2010Varela","sequence":"first","affiliation":[{"name":"Department of Neurology, Duke Comprehensive Epilepsy Center Duke University Medical Center  Durham North Carolina USA"},{"name":"Department of Neurology, Neurocritical Care, and Neurorehabilitation, Center for Cognitive Neuroscience, Member of European Reference Network EpiCARE Christian Doppler University Hospital, Paracelsus Medical University  Salzburg Austria"},{"name":"Centre for Cognitive Neuroscience Neuroscience Institute, Christian Doppler University Hospital, Paracelsus Medical University of Salzburg  Salzburg Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2344-6323","authenticated-orcid":false,"given":"Panagiota\u2010Eleni","family":"Tsalouchidou","sequence":"additional","affiliation":[{"name":"Second Department of Neurology Attikon University Hospital, National and Kapodistrian University of Athens  Athens Greece"},{"name":"Department of Neurology, Epilepsy Center Hessen Philipps University Marburg  Marburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7752-1013","authenticated-orcid":false,"given":"Petra","family":"Levicka","sequence":"additional","affiliation":[{"name":"Department of Neurology Faculty of Medicine P.J. Safarik University Ko\u0161ice, L. Pasteur University Hospital  Ko\u0161ice Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2758-9041","authenticated-orcid":false,"given":"Lara","family":"Wadi","sequence":"additional","affiliation":[{"name":"Department of Neurology, Duke Comprehensive Epilepsy Center Duke University Medical Center  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4863-8674","authenticated-orcid":false,"given":"Elizabeth R.","family":"Blackwood","sequence":"additional","affiliation":[{"name":"Duke University Medical Center Library and Archives  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5950-2692","authenticated-orcid":false,"given":"Eugen","family":"Trinka","sequence":"additional","affiliation":[{"name":"Department of Neurology, Neurocritical Care, and Neurorehabilitation, Center for Cognitive 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