Scientists create detailed brain map that could personalise epilepsy treatment.

Epilepsy treatment: How a new brain map could personalise care

Epilepsy is a neurological disorder characterised by recurrent seizures, and advances in brain mapping are opening new possibilities for more precise, personalised epilepsy treatment. More than 50 million people worldwide live with epilepsy, while approximately one-third continue to experience seizures despite medication.

For people with drug-resistant epilepsy, researchers are increasingly investigating therapies that can target abnormal electrical activity through precisely positioned neuromodulation. New research from Mayo Clinic has produced a detailed map of the pulvinar, a deep structure within the thalamus that could help clinicians refine brain stimulation therapies.

The findings show that tiny regions of the pulvinar can connect to markedly different networks involved in vision, memory, language and attention. This discovery could eventually help doctors tailor epilepsy treatment according to the individual brain networks involved in a patient’s seizures rather than relying on a uniform stimulation target.

Key Takeaways

Epilepsy affects more than 50 million people worldwide.
About one-third of people with epilepsy continue having seizures despite medication.
The pulvinar contains specialised regions connected to different brain networks.
Precise brain mapping could improve personalised neuromodulation for drug-resistant epilepsy.
The research remains part of an evolving effort to make epilepsy treatment more precise and effective.

Understanding epilepsy and its treatment

Epilepsy is a chronic neurological disorder in which a person has a tendency to experience recurrent unprovoked seizures. A seizure occurs when abnormal electrical activity disrupts the normal functioning of networks within the brain.

Seizures can take many forms, depending on which brain networks are involved. Some may produce brief periods of altered awareness, unusual sensations or involuntary movements, while others can cause prominent convulsions and loss of consciousness.

The causes of epilepsy are equally diverse. Genetic factors, structural abnormalities in the brain, developmental conditions, infections, traumatic brain injury, stroke and other neurological disorders can contribute to its development. In some people, despite extensive investigation, no specific cause can be identified.

The principal treatment for many people with epilepsy is antiseizure medication. These medicines work through different mechanisms to reduce the likelihood of abnormal electrical activity spreading through neural networks. Selecting an appropriate medication depends on factors including seizure type, epilepsy syndrome, age, other medical conditions, interactions with existing medicines and potential adverse effects.

Medication can provide excellent seizure control for many patients. Epilepsy treatment, however, becomes substantially more challenging when seizures continue despite appropriate medication trials. This is broadly described as drug-resistant or medication-resistant epilepsy. For these patients, clinicians may consider additional approaches including epilepsy surgery, dietary therapies in selected circumstances, implanted neuromodulation systems and other specialised interventions.

It is within this difficult clinical landscape that the new pulvinar research becomes particularly significant.

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Why the pulvinar matters

The pulvinar is a large nucleus located within the thalamus, a deep structure situated near the centre of the brain. The thalamus has traditionally been described as an important relay and integration centre for information travelling between different regions of the nervous system and the cerebral cortex.

Mayo Clinic’s explanation of the brain and epilepsy explains the relevance of this deep brain anatomy in the context of epilepsy.

The pulvinar has particularly important connections with cortical areas associated with sensory processing, attention and higher cognitive functions. Its location and complex connectivity have historically made it more difficult to study than superficial regions of the brain.

For epilepsy researchers, however, those connections are potentially important because seizures are fundamentally disorders of brain networks. A seizure may originate within one region and propagate through interconnected neural pathways.

Consequently, understanding how individual brain structures communicate with wider networks can help researchers investigate why stimulation of a particular location may influence seizures in one patient but produce a different response in another.

The September 2026 research provides new evidence that the pulvinar should not necessarily be regarded as a single functional unit.

A brain structure more complex than expected

The study, published in the Journal of Neuroscience, examined 30 people with drug-resistant epilepsy who already had temporary electrodes implanted as part of their clinical care.

The researchers used these electrodes to stimulate different parts of the pulvinar with small electrical pulses while recording the brain’s responses. This approach enabled them to observe how stimulation of specific locations influenced activity elsewhere in the brain.

The resulting data produced a detailed functional map of the pulvinar and its connections.

“We were surprised by how large, detailed and complex this deep brain structure is, and by its potential role in guiding epilepsy treatments,” says Dora Hermes Miller, PhD, a biomedical engineer at Mayo Clinic and senior author of the study.

One of the most striking findings was the extraordinary spatial precision of these connections. Brain regions separated by only a few millimetres could connect with substantially different brain networks.

The distinction is clinically important. A stimulation electrode does not interact with the brain in an abstract or uniform manner. Its position, electrical parameters and surrounding anatomy can influence which neural networks are affected.

The research therefore suggests that two electrode placements separated by only a few millimetres could potentially engage different functional networks.

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The unexpected discovery that led to the map

The researchers became interested in the pulvinar through their clinical work with patients whose epilepsy had proved resistant to medication.

As part of their treatment and evaluation, some patients had electrodes placed in several brain regions, including the pulvinar. These electrodes allowed clinicians and researchers to monitor brain activity and investigate whether stimulation could influence seizure activity.

“When we stimulated the pulvinar, we expected to see the same brain networks respond each time,” Dr Hermes says. “Instead, some patients showed activation of visual brain areas while others didn’t. That unexpected finding led us to ask why.”

The answer appears to involve the internal organisation of the pulvinar itself.

Rather than being a uniform structure in which stimulation produces broadly predictable effects, the research indicates that the pulvinar contains specialised subregions with different patterns of connectivity.

Some of these networks are associated with vision, while others are connected with memory, language and attention.

That finding has implications extending beyond epilepsy. It contributes to a broader scientific understanding of how deep brain structures are organised and how precisely the human brain distributes functions across interconnected networks.

For epilepsy treatment, however, the practical implication is particularly important: stimulation may need to be targeted according to the networks involved in an individual’s epilepsy.

What personalised epilepsy treatment could mean

The concept of personalised epilepsy treatment is not entirely new. Modern epilepsy care already uses detailed clinical histories, electroencephalography, magnetic resonance imaging, neuropsychological testing and other investigations to understand each patient’s seizure disorder.

In specialist epilepsy centres, clinicians may combine multiple sources of information to determine where seizures begin, how they spread and whether a surgical or neuromodulatory intervention could be appropriate.

The new pulvinar map could add another layer of information to that process.

“That level of detail means that if neurologists want to suppress the seizures coming from those areas, they have to place electrodes in the precise right spot. And these findings provide a guide towards that spot,” Dr Hermes says.

This is particularly relevant to deep brain stimulation, or DBS, an established neurosurgical technology that has been investigated and used for neurological disorders and, in selected circumstances, epilepsy.

Deep brain stimulation involves surgically implanting electrodes within specific brain structures. The electrodes deliver controlled electrical stimulation generated by an implanted pulse generator. The objective is to alter pathological patterns of neural activity.

In epilepsy, neuromodulation does not necessarily mean eliminating the underlying cause of epilepsy. Instead, the objective can be to reduce seizure frequency, severity or propagation by influencing abnormal network activity.

The approach can therefore be especially relevant when a person’s epilepsy cannot be safely or effectively treated through conventional resective surgery.

Why precision matters in neuromodulation

The brain’s complexity creates a fundamental challenge for stimulation-based treatments. Electrical stimulation affects neural tissue within a region surrounding the electrode, with the precise effects influenced by factors such as electrode geometry, electrical parameters, tissue properties and anatomical connectivity.

If neighbouring regions participate in different functional networks, imprecise targeting could produce unintended effects.

The pulvinar research illustrates why anatomical accuracy and functional connectivity need to be considered together.

A location that appears suitable on a conventional anatomical brain scan may not necessarily represent the optimal functional target for a particular patient. Two people with epilepsy may have clinically similar seizures while their underlying epileptic networks differ.

This is where patient-specific brain mapping could become increasingly valuable.

“These findings provide data that enables exploration of tailoring neuromodulation therapies in a more personalized way, targeting each patient’s specific epilepsy networks,” says Gregory Worrell, MD, PhD, a study co-author and neurologist at Mayo Clinic.

The distinction between personalised targeting and personalised medicine more broadly is important. The research does not mean that doctors can now prescribe a universally effective stimulation location for epilepsy. Instead, it provides a framework that could help clinicians understand the functional anatomy relevant to individual patients.

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The importance of drug-resistant epilepsy

The potential significance of this research is amplified by the large number of people whose seizures are not adequately controlled by medication.

Epilepsy affects more than 50 million people worldwide. About one-third continue to have seizures despite medication. Persistent seizures can have profound consequences, affecting employment, education, driving, independence, relationships and psychological wellbeing. Some forms of epilepsy also carry increased risks of injury and other serious complications.

For patients with drug-resistant epilepsy, treatment therefore involves more than finding another medicine. Specialists may investigate whether seizures originate from a region that can be safely removed surgically. Where resective surgery is unsuitable, neuromodulation may offer another therapeutic pathway.

Mayo Clinic’s research on advancing epilepsy care and neuromodulation describes this broader research direction.

The emerging objective is not simply to stimulate the brain more strongly. It is to stimulate it more intelligently.

Finding the right location and frequency

The current research also raises another important technical question: where should stimulation occur, and how should it be delivered?

Researchers are now investigating which parts of the pulvinar should be stimulated and at what frequencies to achieve better seizure control while minimising unwanted effects.

Frequency is an important component of neuromodulation because neural circuits respond differently to different patterns of electrical stimulation. The duration, amplitude, frequency and timing of stimulation can all influence the resulting physiological response.

Consequently, the future of epilepsy neuromodulation may involve a combination of precise anatomical targeting, functional network mapping and carefully calibrated stimulation parameters.

“Our aim is to make therapy more precise, more consistent and ultimately more effective,” Dr. Gregg says.

This objective reflects a broader evolution in neurological medicine. As imaging, electrophysiology, computational neuroscience and neurosurgical technology improve, clinicians increasingly have the ability to examine the brain at a level of detail that was previously inaccessible.

From brain mapping to clinical treatment

The Mayo Clinic findings have immediate relevance because researchers report that pulvinar maps are already being used to help individualise pulvinar deep brain stimulation targeting in patients with drug-resistant epilepsy.

*”We are already using the pulvinar maps to help individualise pulvinar deep brain stimulation targeting in patients with drug-resistant epilepsy, while continuing to study how these maps relate to long-term outcomes,” says co-author Nick Gregg, MD, a neurologist at Mayo Clinic.

That qualification is important. Mapping can guide treatment, but scientific research must still establish how particular stimulation targets and settings translate into sustained clinical benefits across larger populations.

Long-term outcomes are particularly important because successful epilepsy treatment is measured by meaningful improvements in seizure control, safety and quality of life rather than by changes in brain activity alone.

The study therefore represents an important step in a continuing research programme rather than a definitive replacement for existing epilepsy treatments.

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The future of epilepsy treatment

The research also highlights the collaborative nature of modern epilepsy care. Understanding and treating epilepsy increasingly requires neurologists, neurosurgeons, biomedical engineers, neuroscientists, imaging specialists and other professionals to work together.

Mayo Clinic’s Bioelectronic Neuromodulation Innovation to Cure, or BIONIC, initiative brings together clinicians, scientists and engineers with the objective of translating advances in neuroscience into personalised neuromodulation therapies.

The broader trajectory is clear. Epilepsy treatment is moving towards increasingly detailed characterisation of individual brain networks. Instead of treating seizures exclusively according to their outward clinical appearance, researchers are seeking to understand the underlying electrical and anatomical systems that generate and propagate them.

Brain mapping could eventually make neuromodulation substantially more individualised. A patient’s seizure networks could be mapped, relevant deep brain structures could be identified, stimulation targets could be selected according to their connectivity and treatment parameters could potentially be adjusted according to the patient’s physiological response.

Such an approach could be particularly valuable for people whose epilepsy remains uncontrolled despite medication and who are not candidates for conventional epilepsy surgery.

A more precise approach to epilepsy

The history of epilepsy treatment is marked by successive improvements in understanding. Ancient physicians recognised seizures as a medical phenomenon, although epilepsy was frequently attributed to supernatural causes. The development of modern neurology gradually established the physiological basis of seizures, while the emergence of electroencephalography in the twentieth century gave physicians a means of recording abnormal electrical activity in the brain.

Modern neuroimaging, epilepsy surgery, antiseizure medicines and neuromodulation have subsequently expanded the therapeutic options available to patients.

The new pulvinar research represents another stage in that progression.

Its most important contribution may ultimately be the recognition that precision matters at a scale of only a few millimetres. A deep brain structure that once appeared difficult to understand can now be examined through direct stimulation and measurement, revealing functional distinctions that may be clinically meaningful.

For people living with drug-resistant epilepsy, the significance lies in the possibility of treatment that increasingly reflects the individual organisation of their brain.

The research does not suggest that epilepsy has been solved, nor does it mean that deep brain stimulation is appropriate for every person with epilepsy. Existing medicines, epilepsy surgery, dietary interventions and established neuromodulation approaches remain important components of specialist care, depending on the individual’s diagnosis and circumstances.

What the research demonstrates is that the next generation of epilepsy treatment may depend increasingly on understanding the brain as an interconnected network rather than a collection of isolated structures.

The researchers’ complete study, including authors, disclosures and funding information, is available through the Journal of Neuroscience publication.

For patients and families, the central message is one of measured scientific progress. Epilepsy remains a serious neurological disorder, but advances in mapping, electrophysiology and neuromodulation are giving researchers increasingly sophisticated tools for understanding it.

The ultimate objective is not simply more sophisticated technology. It is better seizure control, fewer treatment-related complications and improved quality of life through therapies designed around the biology of each individual patient’s epilepsy.

About Mayo Clinic

Mayo Clinic is a nonprofit organisation committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Additional Mayo Clinic news is available through the Mayo Clinic News Network.