Caciagli, Lorenzo and Dani S. Bassett
This scientific commentary refers to ‘Decomposing MRI phenotypic heterogeneity in epilepsy: a step towards personalized classification’ by Lee et al. (https://doi.org/10.1093/brain/awab425). Epilepsy is a common, chronic and disabling neurological disorder, and temporal lobe epilepsy (TLE) represents the focal epilepsy archetype. In the last two decades, neuroimaging studies in TLE have captured widespread reorganization of structural and functional circuitry, implicating limbic areas along with whole-brain cortical and subcortical regions. These data have motivated a reconceptualization of TLE as a disorder of neural networks.1 In parallel, investigations leveraging increasingly complex analytical methods have helped reveal the imaging correlates of systems-level reorganization in TLE, and characterized associations between the former and clinical characteristics. Importantly, state-of-the-art imaging metrics have also been employed to successfully predict clinical outcomes, thus showing promise for a swift translation into routine medical practice.