Epilepsy Lecture: Promises and Pitfalls of Translational Epilepsy Imaging

Abstract: MRI and related imaging techniques are central diagnostic tools in neurology and powerful instruments in modern neuroscience. This dual role creates considerable opportunities to translate scientific insights to the bedside, which are not yet fully leveraged. Recent work on blood–brain barrier dysfunction in people with epilepsy across different field strengths demonstrates that epileptic seizures leave measurable “traces” over seconds to hours, opening new avenues for functional seizure imaging that can inform presurgical evaluation. Algorithms for automated detection of potentially epileptogenic lesions developed today may become tomorrow’s clinical research and development systems, ultimately supporting resective epilepsy surgery in individuals with previously undetected lesions (MRI-negative). While attention often centers on artificial intelligence alone, meaningful evaluation requires careful consideration of human performance and human-AI interaction. Ultra-high-field MRI offers unique opportunities for both research and clinical practice, yet early studies temper clinical expectations that it will substantially reduce the number of MRI-negative individuals. In contrast, ultra-low-field MRI provides encouraging prospects for other populations of people with epilepsy. Translation, however, is not unidirectional. Clinical observations in epilepsy can also inform fundamental neuroscience: histories of people with epilepsy – such as individuals after hemispherotomy – offer unique insights into plasticity, functional redundancy of the brain, and the isolated hemisphere as an “island of awareness.” Beyond methodology, this talk highlights key translational challenges at the intersection of open science and clinical reality, including fragmented datasets, privacy regulation, and the need for secure data-trusteeship models that enable large-scale, legally compliant research collaboration. Together, these perspectives outline both the promise and the pitfalls of bringing next-generation neuroimaging from the MRI bore to the bedside in epilepsy care. Finally, the talk turns to a second, often overlooked, translational dimension of epilepsy imaging: ensuring that its benefits reach people with epilepsy in resource-limited settings.

Bio: Theodor Rüber, MD, is an epileptologist/neurologist, and clinician-scientist at the University Hospital Bonn in Germany, where he leads the Translational Neuroimaging and Global Epileptology research groups and serves as Managing Director of the Center for Medical Data Usability and Translation (CMDT). His clinical focus spans complex epilepsies, presurgical evaluation, long-term monitoring, and advanced MRI – including ultra-high- and ultra-low-field imaging. Dr. Rüber is also founder of the data-altruism non-profit deyond and multiple global health and cultural organizations. Recipient of national and international awards, including the Order of Merit of the Federal Republic of Germany and the NRW Young Scientist Award, he is committed to advancing data-enabled epileptology, open science, and socially responsible innovation.For more information, visit The Neuro's website

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