Localising the Seizure Onset Zone from Single-Pulse Electrical Stimulation Responses with a Transformer

Epilepsy is one of the most common neurological disorders, and many patients require surgical intervention when medication fails to control seizures. For effective surgical outcomes, precise localisation of the epileptogenic focus - often approximated through the Seizure Onset Zone (SOZ) - is critical yet remains a challenge. Active probing through electrical stimulation is already standard clinical practice for identifying epileptogenic areas. This paper advances the application of deep learning for SOZ localisation using Single Pulse Electrical Stimulation (SPES) responses. We achieve this by introducing Transformer models that incorporate cross-channel attention. We evaluate these models on held-out patient test sets to assess their generalisability to unseen patients and electrode placements. Our study makes three key contributions: Firstly, we implement an existing deep learning model to compare two SPES analysis paradigms - namely, divergent and convergent. These paradigms evaluate outward and inward effective connections, respectively. Our findings reveal a notable improvement in moving from a divergent (AUROC: 0.574) to a convergent approach (AUROC: 0.666), marking the first application of the latter in this context. Secondly, we demonstrate the efficacy of the Transformer models in handling heterogeneous electrode placements, increasing the AUROC to 0.730. Lastly, by incorporating inter-trial variability, we further refine the Transformer models, with an AUROC of 0.745, yielding more consistent predictions across patients. These advancements provide a deeper insight into SOZ localisation and represent a significant step in modelling patient-specific intracranial EEG electrode placements in SPES. Future work will explore integrating these models into clinical decision-making processes to bridge the gap between deep learning research and practical healthcare applications.