Biomarkers for Post-Traumatic Epilepsy: Advances in Imaging, Molecular Signatures, and AI-Assisted Prediction

Early diagnosis of post-traumatic epilepsy (PTE) is crucial for timely intervention. However, it is hampered by the lack of reliable biomarkers. In this review, we provide a comprehensive summary of current advances in PTE biomarker research covering (i) neuroimaging, including CT, MRI, and EEG/qEEG, which reveal structural and functional alterations associated with epileptogenesis; (ii) molecular biomarkers, including RNAs, proteins, metabolites, and extracellular vesicle (EV)–derived molecules that reflect neuroinflammation, blood–brain barrier dysfunction, neuronal injury, and synaptic remodeling; and (iii) artificial intelligence (AI)–assisted approaches, which integrate multimodal datasets to identify complex predictive patterns. While individual modalities offer valuable but incomplete prognostic information, AI-driven analytics hold the greatest promise for early predictive power when combining multimodal data. Future progress will depend on the combination of high-resolution imaging, multi-omics profiling, and rigorous validation to deliver clinically actionable biomarker panels and ultimately reduce the burden of PTE.