From Standardized Reporting to Multimodal EEG—Integrating Imaging, Biomarkers, and Big Data

Era of Clinical Convergence

In recent years, the standardization of EEG reporting (through systems like SCORE) has ceased to be merely a matter of documentation—it now serves as a backbone for integrating new technologies that are revolutionizing the clinical practice of neurophysiology. The future is multimodal: EEG is fused with magnetic resonance imaging, genetics, high-resolution video, and molecular biomarkers, generating unprecedented synergy for the diagnosis, prognosis, and treatment of epilepsy and other neurological disorders.

The EEG Doesn't Walk Alone: ​​New Data Sources

• Video-EEG and Automated Analysis: The combination of EEG, physiological signals, and video allows for the detection of complex clinical correlates, the differentiation of psychogenic events or abnormal movements, and the training of algorithms that recognize ictal patterns with minimal human intervention.

• Structural and Functional Imaging: The integration of EEG with MRI, PET, and SPECT enables precise anatomical-functional correlations. Modern platforms allow image imports and the marking of epileptogenic zones directly into standardized SCORE reports.

• Genetics and biomarkers: Since 2025, the EEG report includes fields for genetic and proteomic correlation, allowing for risk assessment, syndrome stratification, and treatment personalization.

Big Data and interoperable platforms

• Multicenter and global SCORE databases are now linked with population-based databases and visual analytics tools, enabling:

• Multilayered analysis between EEG, clinical features, imaging, and genomics.

• Identification of rare phenotypes and disease subtypes.

• Prediction of drug response, risk of SUDEP (sudden death in epilepsy), and prediction of in-hospital relapses.

Challenges of multimodal integration

• Universal standards: Different teams and countries are working to align formats (DICOM, HL7, and SCORE), enabling true interoperability between international hospitals and laboratories.

• Data curation and quality: Cross-validation between modalities requires reliable, semantically unambiguous reports with consistent quality control.

• Privacy and ethics: When combining biomedicine, imaging, genetics, and signals, privacy protection must be central; global consortia are developing consensus protocols for anonymization and informed consent.

Disruptive clinical applications

• Refractory epilepsy: Surgeries guided by the integration of standardized EEG and functional magnetic resonance imaging increase success rates and reduce complications.

• ICU monitoring: EEG, cardiac, and respiratory signals fused in real time enable early diagnosis and therapeutic decisions in critically ill patients.

• Neurodevelopment and rare diseases: The correlation of electrographic patterns with genetic phenotypes allows for the discovery of new clinical entities and the adaptation of therapeutic protocols.

The New Frontier: From Structured Reporting to the Brain “Digital Twin”

Standardization not only optimizes daily practice, but also creates an ecosystem for modeling each patient's individual brain—a “digital twin” in which signals, imaging, genetics, and clinical history interact, paving the way for personalized and predictive neurology.

The challenge for the next decade: ensuring that multimodal integration, with a strong standardized foundation, benefits cutting-edge hospitals and remote regions alike, democratizing the best possible brain medicine.