Nomograms Should Not Be Used by General Neurologists When Considering Referral for Epilepsy Surgery

King-Stephens, David

doi:10.1177/15357597221145263

Epilepsy Curr

2022

DOI: 10.1177/15357597221145263

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Nomograms Should Not Be Used by General Neurologists When Considering Referral for Epilepsy Surgery

David King-Stephens¹

Abstract: [Box: see text]

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2024

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Cited by 2 publications

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An ordinal clinical score predicts seizure freedom after minimally invasive epilepsy surgery

Dickey,

Bullinger,

Grogan

et al. 2024

Ann Clin Transl Neurol

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ObjectiveTo predict one‐year seizure freedom, using a combination of relevant clinical variables, following stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy in a series of 101 patients.MethodsEight predictors of seizure freedom were selected based on their association with medial temporal lobe epilepsy: (1) MRI evidence of mesial temporal sclerosis (MTS); (2) unitemporal interictal epileptiform discharges; (3) absence of generalized tonic–clonic seizures; (4) history of febrile seizures; (5) onset of epilepsy ≤16 years; (6) absence of an auditory, visual, or vertiginous aura; and (7) unitemporal ictal onset; (8) unitemporal PET hypometabolism. We compared four multivariate models: “MTS,” using just evidence of MTS; “FULL,” using all eight binary predictors; “AIC” using backwards selection of variables; and “SCORE,” using a 0‐to‐8‐point ordinal score awarding one point for each binary predictor.ResultsIn univariate analysis, significant predictors for seizure freedom were evidence of mesial temporal sclerosis (p = 0.011, Fisher exact) and unitemporal interictal discharges (p = 0.005). For multivariate prediction (using leave one‐out cross‐validation), the ordinal SCORE model had a significantly higher area under the curve (AUC 0.70) than the other three models: MTS (AUC 0.54, p = 0.002, Delong's test), FULL (AUC 0.62, p = 0.003), or AIC (AUC 0.53, p < 0.001).InterpretationAn ordinal score incorporating eight independent binary clinical variables predicted seizure freedom better on novel data than a model using MTS alone, a full multivariate model, or a backwards selected model. The ordinal score model represents a simple clinical heuristic to identify which patients should be offered minimally invasive laser surgery.

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An ordinal clinical score predicts seizure freedom after minimally invasive epilepsy surgery

Dickey,

Bullinger,

Grogan

et al. 2024

Ann Clin Transl Neurol

View full text Add to dashboard Cite

show abstract

Integrating the 5-SENSE Score for Patient Selection in Vagus Nerve Stimulation for Drug-Resistant Epilepsy

Urian,

Rizea,

Costin

et al. 2024

Cureus

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Nomograms Should Not Be Used by General Neurologists When Considering Referral for Epilepsy Surgery

Abstract: [Box: see text]

Cited by 2 publications

References 6 publications

An ordinal clinical score predicts seizure freedom after minimally invasive epilepsy surgery

An ordinal clinical score predicts seizure freedom after minimally invasive epilepsy surgery

Integrating the 5-SENSE Score for Patient Selection in Vagus Nerve Stimulation for Drug-Resistant Epilepsy

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