Leveraging Functional and Structural Connectomics to Guide Neuromodulation in Epilepsy

Epilepsy is not solely a disorder of abnormal brain structure; it is fundamentally a disorder of disrupted brain networks and impaired communication across brain regions. Thalamic neuromodulation, once conceptualized as a fixed, anatomically guided intervention, is now undergoing a paradigm shift toward dynamic, network-informed modulation. Using tools such as stereo-EEG, diffusion MRI, and advanced connectomic analyses, we are entering a new era where neurostimulation strategies can be individualized, responsive, and aligned with the real-time neurophysiology and structural networks of each patient. By integrating anatomic and functional connectivity data, we are moving toward precision neuromodulation tailored to patient-specific seizure networks. In this review, we highlight the emerging role of functional and structural connectivity in refining our understanding of seizure dynamics and guiding neuromodulation interventions.