Prediction tools and risk stratification in epilepsy surgery

Research output: Contribution to journalJournal articleResearchpeer-review

  • Levente Hadady
  • Michael R. Sperling
  • Juan Luis Alcala-Zermeno
  • Jacqueline A. French
  • Patricia Dugan
  • Lara Jehi
  • Dániel Fabó
  • Péter Klivényi
  • Rubboli, Guido
  • Sándor Beniczky

Objective: This study was undertaken to conduct external validation of previously published epilepsy surgery prediction tools using a large independent multicenter dataset and to assess whether these tools can stratify patients for being operated on and for becoming free of disabling seizures (International League Against Epilepsy stage 1 and 2). Methods: We analyzed a dataset of 1562 patients, not used for tool development. We applied two scales: Epilepsy Surgery Grading Scale (ESGS) and Seizure Freedom Score (SFS); and two versions of Epilepsy Surgery Nomogram (ESN): the original version and the modified version, which included electroencephalographic data. For the ESNs, we used calibration curves and concordance indexes. We stratified the patients into three tiers for assessing the chances of attaining freedom from disabling seizures after surgery: high (ESGS = 1, SFS = 3–4, ESNs > 70%), moderate (ESGS = 2, SFS = 2, ESNs = 40%–70%), and low (ESGS = 2, SFS = 0–1, ESNs < 40%). We compared the three tiers as stratified by these tools, concerning the proportion of patients who were operated on, and for the proportion of patients who became free of disabling seizures. Results: The concordance indexes for the various versions of the nomograms were between.56 and.69. Both scales (ESGS, SFS) and nomograms accurately stratified the patients for becoming free of disabling seizures, with significant differences among the three tiers (p <.05). In addition, ESGS and the modified ESN accurately stratified the patients for having been offered surgery, with significant difference among the three tiers (p <.05). Significance: ESGS and the modified ESN (at thresholds of 40% and 70%) stratify patients undergoing presurgical evaluation into three tiers, with high, moderate, and low chance for favorable outcome, with significant differences between the groups concerning having surgery and becoming free of disabling seizures. Stratifying patients for epilepsy surgery has the potential to help select the optimal candidates in underprivileged areas and better allocate resources in developed countries.

Original languageEnglish
JournalEpilepsia
Volume65
Issue number2
Pages (from-to)414-421
Number of pages8
ISSN0013-9580
DOIs
Publication statusPublished - 2024

Bibliographical note

Publisher Copyright:
© 2023 International League Against Epilepsy.

    Research areas

  • epilepsy surgery, prediction tools, risk stratification

ID: 382446275