Electrophysiology–MRI integration for epileptogenic zone detection and surgical prediction – A narrative review

(Invasive) electrophysiology and magnetic resonance imaging (MRI) are central to the presurgical evaluation of patients with focal drug-resistant epilepsy (DRE), providing complementary but incomplete views of the epileptogenic zone (EZ). Although numerous studies combine these modalities, a comprehensive overview of how electrophysiology and MRI can be systematically integrated across MRI modalities is currently lacking. This narrative review synthesizes state-of-the-art methods for integrating electrophysiology with MRI in epilepsy research. Rather than focusing solely on spatial overlap or comparative performance, we highlight approaches in which each modality informs the other. We outline key principles, advantages, and limitations of existing strategies, discuss epilepsy-specific and multimodal integration challenges, and describe methodological directions to address them. Importantly, despite the breadth of proposed approaches, only a small number of integration strategies are currently used in routine clinical practice, whereas many others remain confined to the research domain. We consider emerging opportunities and remaining barriers for clinical translation toward improved localization of the EZ and better prediction of surgical outcomes.