Biomarkers for Epilepsy Deep Brain Stimulation.

Summary: Deep brain stimulation (DBS) of the anterior nucleus of the thalamus is an FDA-approved therapy for drug-resistant focal epilepsy. Recent advances in device technology, thalamic stereotactic-EEG, and chronic sensing have deepened our understanding of corticothalamic networks in epilepsy and identified promising biomarkers to guide and personalize DBS. In this review, we examine electrophysiological, imaging, and clinical biomarkers relevant to epilepsy DBS, with a focus on their potential to support seizure detection, target engagement, network excitability tracking, and seizure risk forecasting. We highlight emerging insights from thalamic sEEG, including both passive recordings and active stimulation protocols, which enable mapping and modulation of large-scale brain networks. The capabilities of clinical sensing-enabled DBS systems are reviewed. As device functionality and biomarker discovery evolve, concerted translational efforts are needed to realize a new paradigm of personalized DBS in epilepsy.