{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T03:13:44Z","timestamp":1771038824424,"version":"3.50.1"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:00:00Z","timestamp":1756425600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neuroinform."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Accurate localization of the epileptogenic zone is essential for surgical treatment of drug-resistant epilepsy. Standard presurgical evaluations rely on multimodal neuroimaging techniques, but these may be limited by availability and interpretive challenges. This study aimed to assess the concordance between zones identified by ictal semiology and a novel distributed electrical source localization technique, CLARA, and to evaluate their impact on postsurgical outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective study included 16 patients with at least three recorded seizures. Ictal semiology was analyzed subjectively using video electroencephalography (VEEG) by a multidisciplinary team of neurologists, neurophysiologists, and radiologists, who determined the presumed epileptogenic zone at the lobar level. CLARA was subsequently applied to identify the computed zone based on ictal and\/or interictal biomarker activities. The concordance between the presumed and computed zones was assessed qualitatively. Postsurgical outcomes were examined in relation to the extent of resection of the CLARA-defined zones.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among thirteen patients with sufficient data for analysis, qualitative comparison showed 77% concordance and 23% partial concordance between the presumed and computed zones. Postsurgical follow-up revealed seizure freedom in one patient with cavernoma following complete resection of the CLARA-defined zone. In contrast, patients with incomplete resection of this region continued to experience seizures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>The findings support the potential value of CLARA as an adjunctive neuroimaging technique in the presurgical evaluation of epilepsy. By providing an additional layer of verification, CLARA may improve the accuracy of epileptogenic zone localization when used alongside established modalities such as PET, SPECT, fMRI, and MRI. Its adaptability and lower resource requirements suggest particular utility in centers with limited access to advanced medical equipment and specialized personnel. Broader implementation of CLARA could enhance presurgical decision-making and contribute to improved surgical outcomes for epilepsy patients.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fninf.2025.1661617","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T05:46:22Z","timestamp":1756446382000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Epileptic brain imaging by source localization CLARA supported by ictal-based semiology and VEEG in resource-limited settings"],"prefix":"10.3389","volume":"19","author":[{"given":"Amir F.","family":"Al-Bakri","sequence":"first","affiliation":[]},{"given":"Ahmed Tahseen","family":"Muslim","sequence":"additional","affiliation":[]},{"given":"Moneer K.","family":"Faraj","sequence":"additional","affiliation":[]},{"given":"Wamedh","family":"Esam Matti","sequence":"additional","affiliation":[]},{"given":"Radana","family":"Vilimkova Kahankova","sequence":"additional","affiliation":[]},{"given":"Dariusz","family":"Mikolajewski","sequence":"additional","affiliation":[]},{"given":"Waldemar","family":"Karwowski","sequence":"additional","affiliation":[]},{"given":"Aleksandra","family":"Kawala-Sterniuk","sequence":"additional","affiliation":[]}],"member":"1965","published-online":{"date-parts":[[2025,8,29]]},"reference":[{"key":"B1","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1109\/EMBC.2018.8512339","article-title":"\u201cEffect of vigilance changes on the incidence of high frequency oscillations in the epileptic brain,\u201d","volume-title":"2018 40th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC)","author":"Al-Bakri","year":"2018"},{"key":"B2","doi-asserted-by":"publisher","first-page":"108740","DOI":"10.1016\/j.jneumeth.2020.108740","article-title":"A systematic review of EEG source localization techniques and their applications on diagnosis of brain abnormalities","volume":"339","author":"Asadzadeh","year":"2020","journal-title":"J. Neurosci. Methods"},{"key":"B3","doi-asserted-by":"publisher","first-page":"107135","DOI":"10.1016\/j.compbiomed.2023.107135","article-title":"Implementation of artificial intelligence and machine learning-based methods in brain-computer interaction","volume":"163","author":"Barnova","year":"2023","journal-title":"Comput. Biol. Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1743","DOI":"10.1111\/epi.12339","article-title":"Source localization of rhythmic ictal EEG activity: a study of diagnostic accuracy following stard criteria","volume":"54","author":"Beniczky","year":"2013","journal-title":"Epilepsia"},{"key":"B5","doi-asserted-by":"publisher","first-page":"751510","DOI":"10.1155\/2012\/751510","article-title":"Temporal lobe epilepsy semiology","volume":"2012","author":"Blair","year":"2012","journal-title":"Epilepsy Res. Treat"},{"key":"B6","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1097\/WNP.0000000000001029","article-title":"Technical considerations in EEG source imaging","volume":"41","author":"Brinkmann","year":"2024","journal-title":"J. Clin. Neurophysiol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"2887","DOI":"10.1093\/brain\/awr243","article-title":"Electroencephalographic source imaging: a prospective study of 152 operated epileptic patients","volume":"134","author":"Brodbeck","year":"2011","journal-title":"Brain"},{"key":"B8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1109\/SPMB.2011.6120106","article-title":"\u201cAccurate 3D source localization of focal epileptic foci using interictal EEG spikes,\u201d","volume-title":"2011 IEEE Signal Processing in Medicine and Biology Symposium (SPMB)","author":"Cabrerizo","year":"2011"},{"key":"B9","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1136\/practneurol-2019-002341","article-title":"Localisation in focal epilepsy: a practical guide","volume":"21","author":"Chowdhury","year":"2021","journal-title":"Pract. Neurol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1097\/WNP.0b013e318038fd52","article-title":"EEG source imaging: correlating source locations and extents with electrocorticography and surgical resections in epilepsy patients","volume":"24","author":"Ding","year":"2007","journal-title":"J. Clin. Neurophysiol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e576","DOI":"10.1212\/WNL.0000000000006877","article-title":"Electromagnetic source imaging in presurgical workup of patients with epilepsy: a prospective study","volume":"92","author":"Duez","year":"2019","journal-title":"Neurology"},{"key":"B12","volume-title":"A Disease Once Sacked: A History of the Medical Understanding of Epilepsy","author":"Eadie","year":"2001"},{"key":"B13","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1016\/j.seizure.2018.08.026","article-title":"Lateralizing and localizing value of seizure semiology: comparison with scalp EEG, MRI and pet in patients successfully treated with resective epilepsy surgery","volume":"61","author":"Elwan","year":"2018","journal-title":"Seizure"},{"key":"B14","doi-asserted-by":"publisher","first-page":"201","DOI":"10.3345\/cep.2022.00962","article-title":"Electroencephalography source localization","volume":"66","author":"Eom","year":"2023","journal-title":"Clin. Exp. Pediatrics"},{"key":"B15","doi-asserted-by":"publisher","first-page":"2022","DOI":"10.1212\/WNL.57.11.2022","article-title":"The localizing value of ictal EEG in focal epilepsy","volume":"57","author":"Foldvary","year":"2001","journal-title":"Neurology"},{"key":"B16","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/j.yebeh.2010.08.034","article-title":"Localizing and lateralizing features of auras and seizures","volume":"20","author":"Foldvary-Schaefer","year":"2011","journal-title":"Epilepsy Behav"},{"key":"B17","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1016\/j.seizure.2022.04.003","article-title":"A descriptive study of eye and head movements in versive seizures","volume":"98","author":"Fotedar","year":"2022","journal-title":"Seizure"},{"key":"B18","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1016\/B978-0-12-823493-8.00021-3","article-title":"Semiology, EEG, and neuroimaging findings in temporal lobe epilepsies","volume":"187","author":"Frazzini","year":"2022","journal-title":"Handb. Clin. Neurol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1111\/j.1528-1157.2000.tb01508.x","article-title":"Dipole-source analysis in a realistic head model in patients with focal epilepsy","volume":"41","author":"Herrendorf","year":"2000","journal-title":"Epilepsia"},{"key":"B20","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1016\/j.pediatrneurol.2006.12.002","article-title":"Semiological seizure classification: before and after video- EEG monitoring of seizures","volume":"36","author":"Hirfanoglu","year":"2007","journal-title":"Pediatr. Neurol"},{"key":"B21","first-page":"1","article-title":"\u201cBESA research tutorial 4: distributed source imaging,\u201d","author":"Hoechstetter","year":"2010","journal-title":"BESA Research Tutorial"},{"key":"B22","doi-asserted-by":"publisher","first-page":"746","DOI":"10.3389\/fnins.2018.00746","article-title":"Loreta with cortical constraint: choosing an adequate surface laplacian operator","volume":"12","author":"Iordanov","year":"2018","journal-title":"Front. Neurosci"},{"key":"B23","first-page":"8","article-title":"\u201cClara: classical loreta analysis recursively applied,\u201d","volume-title":"20th Annual Meeting of Organization of Human Brain Mapping (OHBM)","author":"Iordanov","year":"2014"},{"key":"B24","doi-asserted-by":"publisher","first-page":"e121981","DOI":"10.5812\/ijp-121981","article-title":"Non-invasive electrical source imaging for localizing epileptiform discharges in children with focal epilepsy based on developing country's limitations","volume":"33","author":"Irandoost","year":"2023","journal-title":"Innov. J. Pediatrics"},{"key":"B25","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1017\/S0317167100007526","article-title":"Seizure semiology: value in identifying seizure origin","volume":"35","author":"Jan","year":"2008","journal-title":"Can. J. Neurol. Sci"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1351","DOI":"10.1007\/s12551-023-01138-6","article-title":"Review on brain-computer interface technologies in healthcare","volume":"15","author":"Karikari","year":"2023","journal-title":"Biophys. Rev"},{"key":"B27","doi-asserted-by":"publisher","first-page":"43","DOI":"10.3390\/brainsci11010043","article-title":"Summary of over fifty years with brain-computer interfaces\u2014a review","volume":"11","author":"Kawala-Sterniuk","year":"2021","journal-title":"Brain Sci"},{"key":"B28","doi-asserted-by":"publisher","first-page":"e16097","DOI":"10.1111\/ene.16097","article-title":"Anti-seizure medication response and the glymphatic system in patients with focal epilepsy","volume":"31","author":"Kim","year":"2024","journal-title":"Eur. J. Neurol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1002\/ana.21419","article-title":"Functional imaging: II. prediction of epilepsy surgery outcome","volume":"64","author":"Knowlton","year":"2008","journal-title":"Ann. Neurol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1056\/NEJM200002033420503","article-title":"Early identification of refractory epilepsy","volume":"342","author":"Kwan","year":"2000","journal-title":"New Engl. J. Med"},{"key":"B31","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1097\/00004691-200309000-00003","article-title":"Propagation of interictal epileptiform activity can lead to erroneous source localizations: a 128-channel EEG mapping study","volume":"20","author":"Lantz","year":"2003","journal-title":"J. Clin. Neurophysiol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"2127","DOI":"10.1016\/j.clinph.2015.12.021","article-title":"Epileptiform discharge propagation: analyzing spikes from the onset to the peak","volume":"127","author":"M\u0103l\u00eeia","year":"2016","journal-title":"Clin. Neurophysiol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"2303","DOI":"10.3390\/diagnostics12102303","article-title":"Electric source imaging in presurgical evaluation of epilepsy: an inter-analyser agreement study","volume":"12","author":"Mattioli","year":"2022","journal-title":"Diagnostics"},{"key":"B34","doi-asserted-by":"publisher","first-page":"317","DOI":"10.2147\/NSS.S152624","article-title":"Sleep-related hypermotor epilepsy: prevalence, impact and management strategies","volume":"10","author":"Menghi","year":"2018","journal-title":"Nat. Sci. Sleep"},{"key":"B35","doi-asserted-by":"publisher","first-page":"325","DOI":"10.3389\/fneur.2019.00325","article-title":"EEG source imaging: a practical review of the analysis steps","volume":"10","author":"Michel","year":"2019","journal-title":"Front. Neurol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"3275","DOI":"10.1016\/j.neuroimage.2011.11.048","article-title":"Time course of ERP generators to syllables in infants: a source localization study using age-appropriate brain templates","volume":"59","author":"Ortiz-Mantilla","year":"2012","journal-title":"Neuroimage"},{"key":"B37","doi-asserted-by":"publisher","first-page":"109615","DOI":"10.1016\/j.yebeh.2023.109615","article-title":"Ambulatory EEG-video","volume":"151","author":"Ot\u00e1rula","year":"2024","journal-title":"Epilepsy Behav"},{"key":"B38","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1111\/j.1528-1167.2007.01381.x","article-title":"EEG source localization in focal epilepsy: where are we now?","volume":"49","author":"Plummer","year":"2008","journal-title":"Epilepsia"},{"key":"B39","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1097\/WNP.0000000000001012","article-title":"Interictal electrical source imaging","volume":"41","author":"Rampp","year":"2024","journal-title":"J. Clin. Neurophysiol"},{"key":"B40","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1007\/s10548-020-00768-3","article-title":"Respective contribution of ictal and inter-ictal electrical source imaging to epileptogenic zone localization","volume":"33","author":"Rikir","year":"2020","journal-title":"Brain Topogr"},{"key":"B41","doi-asserted-by":"publisher","first-page":"1683","DOI":"10.1093\/brain\/124.9.1683","article-title":"Presurgical evaluation of epilepsy","volume":"124","author":"Rosenow","year":"2001","journal-title":"Brain"},{"key":"B42","doi-asserted-by":"publisher","first-page":"1114","DOI":"10.1016\/S1474-4422(14)70156-5","article-title":"Epilepsy surgery in children and adults","volume":"13","author":"Ryvlin","year":"2014","journal-title":"Lancet Neurol"},{"key":"B43","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1097\/00019052-200304000-00008","article-title":"The epidemiology of epilepsy revisited","volume":"16","author":"Sander","year":"2003","journal-title":"Curr. Opin. Neurol"},{"key":"B44","doi-asserted-by":"publisher","first-page":"1250","DOI":"10.3389\/fneur.2019.01250","article-title":"Accuracy of interictal and ictal electric and magnetic source imaging: a systematic review and meta-analysis","volume":"10","author":"Sharma","year":"2019","journal-title":"Front. Neurol"},{"key":"B45","doi-asserted-by":"publisher","first-page":"2476","DOI":"10.1111\/epi.17361","article-title":"From theory to practical fundamentals of electroencephalographic source imaging in localizing the epileptogenic zone","volume":"63","author":"Singh","year":"2022","journal-title":"Epilepsia"},{"key":"B46","doi-asserted-by":"publisher","first-page":"106519","DOI":"10.1016\/j.yebeh.2019.106519","article-title":"Source localization of high-frequency activity in tripolar electroencephalography of patients with epilepsy","volume":"101","author":"Toole","year":"2019","journal-title":"Epilepsy Behav"},{"key":"B47","doi-asserted-by":"publisher","first-page":"811","DOI":"10.3390\/diagnostics12040811","article-title":"Comparison of qualitative and quantitative analyses of MR-arterial spin labeling perfusion data for the assessment of pediatric patients with focal epilepsies","volume":"12","author":"Tortora","year":"2022","journal-title":"Diagnostics"}],"container-title":["Frontiers in Neuroinformatics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fninf.2025.1661617\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T05:46:23Z","timestamp":1756446383000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fninf.2025.1661617\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,29]]},"references-count":47,"alternative-id":["10.3389\/fninf.2025.1661617"],"URL":"https:\/\/doi.org\/10.3389\/fninf.2025.1661617","relation":{},"ISSN":["1662-5196"],"issn-type":[{"value":"1662-5196","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,29]]},"article-number":"1661617"}}