Predicting outcome of epilepsy surgery in clinical practice: Prediction models vs. clinical acumen

Anne Katharina Fassin; Susanne Knake; Adam Strzelczyk; Colin B Josephson; Philipp S Reif; Anja Haag; Barbara Carl; Anke M Hermsen; Iris Gorny; Leona Möller; Axel Pagenstecher; Christopher Nimsky; Sebastian Bauer; Ulrich Sure; Katja Menzler; Felix Rosenow; Karl Martin Klein

doi:10.1016/j.seizure.2020.01.016

Predicting outcome of epilepsy surgery in clinical practice: Prediction models vs. clinical acumen

Seizure. 2020 Feb 1:76:79-83. doi: 10.1016/j.seizure.2020.01.016. Online ahead of print.

Authors

Anne Katharina Fassin¹, Susanne Knake¹, Adam Strzelczyk², Colin B Josephson³, Philipp S Reif², Anja Haag¹, Barbara Carl⁴, Anke M Hermsen⁵, Iris Gorny¹, Leona Möller¹, Axel Pagenstecher⁶, Christopher Nimsky⁴, Sebastian Bauer², Ulrich Sure⁷, Katja Menzler¹, Felix Rosenow², Karl Martin Klein⁸

Affiliations

¹ Epilepsy Center Hessen, Department of Neurology, University Hospitals Giessen & Marburg, Philipps-University Marburg, Marburg, Germany.
² Epilepsy Center Hessen, Department of Neurology, University Hospitals Giessen & Marburg, Philipps-University Marburg, Marburg, Germany; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Center of Neurology and Neurosurgery, University Hospital, Goethe-University Frankfurt, Germany; Center for Personalized Translational Epilepsy Research (CePTER), Goethe University, Frankfurt, Germany.
³ Departments of Clinical Neurosciences and Community Health Sciences, O'Brien Institute for Public Health, Hotchkiss Brain Institute, Center for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁴ Department of Neurosurgery, University Hospitals Giessen & Marburg, Philipps-University Marburg, Marburg, Germany.
⁵ Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Center of Neurology and Neurosurgery, University Hospital, Goethe-University Frankfurt, Germany; Center for Personalized Translational Epilepsy Research (CePTER), Goethe University, Frankfurt, Germany.
⁶ Department of Neuropathology, Philipps-University Marburg, Marburg, Germany.
⁷ Department of Neurosurgery, University Hospital Essen, and University Duisburg-Essen, Essen, Germany.
⁸ Epilepsy Center Hessen, Department of Neurology, University Hospitals Giessen & Marburg, Philipps-University Marburg, Marburg, Germany; Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Center of Neurology and Neurosurgery, University Hospital, Goethe-University Frankfurt, Germany; Center for Personalized Translational Epilepsy Research (CePTER), Goethe University, Frankfurt, Germany; Departments of Clinical Neurosciences, Medical Genetics and Community Health Sciences, Hotchkiss Brain Institute & Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Electronic address: karl.klein@ucalgary.ca.

PMID: 32035367
DOI: 10.1016/j.seizure.2020.01.016

Abstract

Purpose: Epilepsy surgery is an evidence-based treatment for drug-refractory focal epilepsy. We aimed to evaluate how well preoperative outcome estimates of epilepsy surgery in clinical practice correlated with postoperative outcome and to compare prediction by the clinical team with available scores (m-SFS, ESN).

Method: Retrospective cohort study including patients with drug-refractory focal epilepsy who underwent resective epilepsy surgery at Epilepsy Center Hessen, Marburg, between 1998-2016. Patients were categorized into four groups based on their estimated chance of postoperative seizure freedom documented in preoperative medical records. Variables required for calculation of m-SFS and ESN were also extracted from presurgical medical records. Seizure outcome using Engel/ILAE classifications was extracted from postoperative medical records.

Results: 148 patients were included and 98 had follow-up at 5 years. 69 (70%) had Engel I and 50 (51%) ILAE 1 outcome. Observed 5-year outcome for very good candidates was 20/22 (91%) Engel I and 14/22 (64%) ILAE 1, for good candidates 29/40 (73%) Engel I and 21/40 (53%) ILAE 1, for candidates with slightly reduced chance 11/18 (61%) Engel I and 9/18 (50%) ILAE 1 and for candidates with considerably reduced chance 1/5 (20%) Engel I and 1/5 (20%) ILAE 1.There were no significant differences in discrimination or overall performance between predictions by the clinical team, ESN and m-SFS.

Conclusions: Preoperative outcome estimates corresponded well with observed outcome indicating adequate patient counseling.

Keywords: Epilepsy; Epilepsy surgery; Outcome prediction; Prediction models; Presurgical evaluation.