Towards precision MRI biomarkers in epilepsy with normative modelling

Epilepsy is recognized as one of the leading targets for precision medicine, following on from the successes in cancer therapy, due to its substantial clinical heterogeneity and divergent therapeutic options. To bring personalized care to the epilepsies, there is a need for appropriate precision biomarkers that can identify disease processes or predict treatment outcomes at the individual patient level. Neuroimaging techniques, including MRI, have been transformative for clinical practice, particularly in medically refractory focal epilepsies. Advanced MRI techniques have the potential to bring precision medicine clearly into view for epileptology; however, there are challenges that must be overcome before cutting-edge neuroimaging tools can be used in clinical practice. In this review article, we communicate our view that implementation of normative modelling frameworks will help to deliver robust quantitative MRI biomarkers for individualized prediction. Here, we provide recommendations for researchers and clinicians alike, from careful research design to clinical applications, that will help to identify diagnostic and predictive imaging biomarkers. Such precision markers will be key to delivering personalized medicine for the epilepsies.