Localizing seizure onset zone by a cortico-cortical evoked potentials-based machine learning approach in focal epilepsy

•A novel automated approach was proposed for localizing seizure onset zone (SOZ) by cortico-cortical evoked potentials (CCEPs).•Cortical hyperexcitability at the stim-SOZ/rec-SOZ sites was increased in patients with hippocampus sclerosis compared to those with focal cortical dysplasia IIa.•The patients with complex partial seizures have more distinctive characteristics of CCEP than those with generalized tonic-clonic seizures in areas with different epileptogenicity. We aimed to develop a new approach for identifying the localization of the seizure onset zone (SOZ) based on corticocortical evoked potentials (CCEPs) and to compare the connectivity patterns in patients with different clinical phenotypes. Fifty patients who underwent stereoelectroencephalography and CCEP procedures were included. Logistic regression was used in the model, and six CCEP metrics were input as features: root mean square of the first peak (N1RMS) and second peak (N2RMS), peak latency, onset latency, width duration, and area. The area under the curve (AUC) for localizing the SOZ ranged from 0.88 to 0.93. The N1RMS values in the hippocampus sclerosis (HS) group were greater than that of the focal cortical dysplasia (FCD) IIa group (p