Responsive neurostimulation leads targeting intracranial sites with ictal high‐frequency oscillation onset patterns are associated with better 2‐year seizure control outcomes

Our results suggest that ictal HFOs provide additional localization value. Ictal HFOs represent very local epileptiform activity that may reflect closer proximity to epileptogenic tissue than conventional features such as spiking and slower rhythms. Because stimulation acts by focal tissue activation, increased targeting precision may be more important in RNS than surgeries such as resection or ablation.