Dataset Information

Predicting seizure freedom after epilepsy surgery, a challenge in clinical practice.

ABSTRACT:

Objective

The objective of this study was to compare the accuracy of clinical judgment in predicting seizure outcome after resective epilepsy surgery relative to two recently published statistical tools [the Epilepsy Surgery Nomogram (ESN) and the modified Seizure-Freedom score (m-SFS)].

Methods

Details of presurgical evaluations of 20 patients who underwent epilepsy surgery were presented to 20 epilepsy experts. The final surgical treatment was also disclosed. The clinicians were asked to predict the likelihood of a good outcome (Engel 1) at 2 and 5?years in each case. The ESN and the m-SFS predictions were calculated with the data provided to the clinicians. The discriminative ability of clinical judgment, ESN, and m-SFS was assessed by calculating a concordance index (C-index). Expert opinion, the m-SFS and the ESN performances were compared using a Receiver Operating Characteristic (ROC) curve analysis.

Results

The mean age at surgery was 29?years (standard deviation [SD]?=?14); 40% were male; 70% were right-handed, and thirteen (65%) had an Engel outcome 1 at 2 and 5?years. The mean C-index for the mean physician's prediction was 0.478 with a variance of 0.012. The ESN had an area under the curve (AUC) of 0.528 and 0.533 for the 2-year and 5-year predictions in comparison with the clinicians' predictions that was 0.476, and 0.466, respectively. For the m-SFS, the AUC at 2?years and 5?years was 0.539 and 0.539, respectively. No statistical difference was noted between the ESN and the clinicians or between m-SFS and the ESN, but there is a moderate statistical difference favoring the m-SFS to the clinicians (p 0.0960 and 0.0514, for 2 and 5?years).

Significance

Clinical judgment was not superior to the ESN nor to the m-SFS. Together with the interphysician's prediction variability, our findings reinforce the need for better tools to predict postoperative outcomes.

SUBMITTER: Gracia CG

PROVIDER: S-EPMC6546523 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Publications

Predicting seizure freedom after epilepsy surgery, a challenge in clinical practice.

Gracia Camilo Garcia CG Chagin Kevin K Kattan Michael W MW Ji Xinge X Kattan Madeleine G MG Crotty Lizzie L Najm Imad I Gonzalez-Martinez Jorge J Bingaman William W Jehi Lara L

Epilepsy & behavior : E&B 20190428

<h4>Objective</h4>The objective of this study was to compare the accuracy of clinical judgment in predicting seizure outcome after resective epilepsy surgery relative to two recently published statistical tools [the Epilepsy Surgery Nomogram (ESN) and the modified Seizure-Freedom score (m-SFS)].<h4>Methods</h4>Details of presurgical evaluations of 20 patients who underwent epilepsy surgery were presented to 20 epilepsy experts. The final surgical treatment was also disclosed. The clinicians were ...[more]

PMID: 31035104

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Project description:Objective: Central nervous system infections (CNSIs), especially viral encephalitis and meningitis, are well-recognized causes of medically refractory epilepsy. Although surgery is an effective and durable intervention against these infections, the seizure control outcomes described in previous surgical series have been variable. Accordingly, it is not clear which variables are most valuable in predicting seizure control following surgery for CNSI. The aim of this meta-analysis was to identify the predictors of favorable surgical outcomes in CNSI-related epilepsy. Methods: The PubMed, EMBASE, Cochrane Library, WANGFANG, VIP, CBM, and CNKI databases were searched for studies according to the inclusion criteria. Prognostic factors, surgical outcomes, and patient characteristics were extracted. Heterogeneity was detected by the I2 and Q statistics. Results: Seventeen studies were included in our meta-analysis. Eight predictors of favorable outcomes (Engel Class I/II) were determined, including abnormal MRI findings, meningitis, temporal location only, regional ictal pattern, unilateral ictal pattern, older age at epilepsy, longer silent period, and longer time from infection, as follows: OR = 3.34 (95% CI 1.44-7.74), OR = 0.31 (95% CI 0.13-0.70), OR = 0.34 (95% CI 0.16-0.74), OR = 5.65 (95% CI 1.75-18.30), and OR = 9.53 (95% CI 2.36-38.48), respectively, and MD = 2.15 (95% CI 0.20-4.11), MD = 2.40 (95% CI 0.09-4.70), and MD = 8.49 (95% CI 1.50-15.48), respectively. A subgroup analysis found the following associations: regional and unilateral ictal patterns in viral encephalitis, a younger age at infection in parasitic encephalopathy, an older age at surgery, a longer time from onset, and a longer time from infection in unexplained meningitis. A sensitivity analysis restricted to studies that included each variable yielded robust results. Little evidence of publication bias was observed. Conclusions: This meta-analysis suggests that abnormal MRI findings, meningitis, temporal location only, regional and unilateral ictal patterns, older age at epilepsy, longer silent period, and longer time from infection are predictive factors in patients with favorable surgical outcomes in CNSI-related epilepsy. In addition, different infective agents influenced the results in regional and unilateral ictal patterns in ictal electroencephalography, as well as the relationship between age at infection and surgery and the time from epilepsy onset and infection.

Dataset Information

Predicting seizure freedom after epilepsy surgery, a challenge in clinical practice.

Objective

Methods

Results

Significance

Publications

Predicting seizure freedom after epilepsy surgery, a challenge in clinical practice.

Similar Datasets

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