Integration of iEEG local microstate dynamics and neuro rank graph score for accurate SOZ localization

Objective.Accurate localization of the seizure onset zone (SOZ) is critical for successful surgical intervention in drug-resistant epilepsy. high frequency oscillation (HFO)-based SOZ localization methods often exhibit limited accuracy, which constrains their ability to reliably track large-scale and dynamic brain network activity. Microstate analysis captures dynamic spatiotemporal patterns of epileptogenic networks, improving localization. Propagation zone electrodes can mimic SOZ activity and complicate mapping. This study aims to enhance SOZ precision by combining microstate analysis with a Neuro Rank scoring system to eliminate false positives including propagation zone electrodes while prioritizing true SOZ regions.Approach.We developed a framework integrating HFO detection, microstate analysis, and Neuro Rank-based propagation zone refinement. HFOs were detected and characterized using time-frequency features and clustered via fuzzy C-means. Microstate analysis identified dominant spatiotemporal patterns using global field power (GFP) peaks. Electrodes identified by both methods were refined using Neuro Rank, which integrates PageRank (PR), reverse PR, and hyperlink-induced topic search to down-weight propagation zone electrodes while highlighting true SOZ activity.Main results.Using a leave-one-patient-out evaluation, the proposed pipeline combining HFO, microstate features, and Neuro Rank achieved the best performance on the Freiburg dataset with 95.71% accuracy, 74.83% sensitivity, 98.56% specificity, and an Area Under the receiver operating characteristic Curve (AUC) of 0.83, while demonstrating strong generalization on the external HUP dataset with 96.34% accuracy, 72.34% sensitivity, 97.88% specificity, and an AUC of 0.80.Significance.Combining local HFO biomarkers, microstate-derived network dynamics, and Neuro Rank suppression of propagation zone electrodes provides precise and reliable SOZ localization, supporting improved surgical planning and outcomes in drug-resistant epilepsy.Terms-SOZ localization, intracranial EEG, HFOs, EEG microstate analysis, Neuro Rank graph score.