Clinical Translation of Optically Pumped Magnetometer-Based Magnetoencephalography: Current Evidence, Implementation Challenges, and Future Pathways

Optically pumped magnetometer-based magnetoencephalography (OPM-MEG) enables cryogen-free, on-scalp recordings with wearable, individually configurable sensor arrays. These features may expand access to MEG for patients poorly accommodated by fixed-helmet superconducting quantum interference device (SQUID) systems. This review evaluates current clinical evidence, implementation barriers, and priorities for clinical translation. This narrative review synthesizes OPM-MEG studies in presurgical epilepsy evaluation and functional mapping, alongside exploratory applications in other neurological and psychiatric conditions. Evidence is considered in relation to clinical performance, validation endpoints, and requirements for acquisition, analysis, and implementation across different clinical settings. Patient-based evidence includes comparative and prospective studies of presurgical evaluation in drug-resistant focal epilepsy. Studies support interictal epileptiform discharge detection and localization, with broad concordance with SQUID-MEG and intracranial electrophysiology; early reports also demonstrate ictal recordings. Pediatric and motion-tolerant recordings represent promising applications. Motor mapping has progressed to small patient cohorts with limited intraoperative validation, while language mapping is supported mainly by small studies and case reports. Applications in neurodegenerative, headache, psychiatric, and developmental disorders remain exploratory and currently lack established clinical indications for MEG. Common translational priorities include standardized performance benchmarks, acquisition quality control, motion management, co-registration, analysis, reporting, and personnel training. OPM-MEG shows promise for extending clinical MEG, supported by patient-based feasibility and comparative studies in presurgical epilepsy evaluation. Multicenter prospective studies should establish performance and reproducibility for defined indications. New applications and claims of additional benefit require evaluation of their effects on clinical management and patient outcomes, supported by standardized workflows across systems and centers.