Garcia Gracia Camilo, Yardi Ruta, Kattan Michael W, Nair Dileep, Gupta Ajay, Najm Imad, Bingaman William, Gonzalez-Martinez Jorge, Jehi Lara
Cleveland Clinic Epilepsy Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A.
Epilepsia. 2015 Mar;56(3):359-65. doi: 10.1111/epi.12892. Epub 2014 Dec 20.
We aim to develop a new scale that predicts seizure outcomes after resective epilepsy surgery.
We retrospectively reviewed patients who underwent surgery for medically refractory epilepsy at our center between 1999 and 2012. Four predictive outcome indicators were selected: preoperative seizure frequency, history of generalized tonic-clonic seizures, brain magnetic resonance imaging (MRI), and epilepsy duration. A score of 0 or 1 was given if the indicator was associated with poor or good outcome, respectively. A seizure freedom score (SFS) was calculated by adding these four categories (total score ranged from 0 to 4). A modified SFS (m-SFS) was then calculated with two additional outcome indicators: invasive electroencephalography (EEG) evaluation (IEI) (performed or not performed) and lobe of resection (temporal vs. extratemporal), for a score ranging from 0 to 6. Kaplan-Meier survival analysis was used to calculate the probability of seizure freedom in the overall group. Statistical significance was tested using the log-rank test and comparison of 95% confidence intervals (CIs).
The study population included 466 patients with 244 (52%) male. Seizure freedom rates were directly correlated with the SFS score: at 10 years, 36.9% of patients with SFS of 0 were seizure-free, as opposed to 45% for SFS = 1, 60% for SFS = 2, 72% for SFS 3 or above (p = 0.002). When calculated including the IEI and the localization, the score's performance improved: 24% of patients with a m-SFS of 0 were seizure-free at 10 years, as opposed to 38-59% for m-SFS = 1-3, and 75-79% for m-SFS of 4-6 (p < 0.001).
An easily measurable seizure freedom score could be a reliable tool to synthesize multiple seizure outcome predictors into a single simple score to predict postoperative seizure freedom. This tool will help with patient and family counseling and estimation of surgical candidacy at both early (SFS) and advanced (m-SFS) stages of a surgical evaluation.
我们旨在开发一种新的量表，用于预测切除性癫痫手术后的癫痫发作结果。
我们回顾性分析了1999年至2012年间在本中心接受药物难治性癫痫手术的患者。选择了四个预测结果指标：术前癫痫发作频率、全身强直阵挛性发作病史、脑磁共振成像（MRI）和癫痫病程。如果该指标与不良或良好结果相关，则分别给予0分或1分。通过将这四个类别相加计算癫痫发作缓解评分（SFS）（总分范围为0至4）。然后，使用另外两个结果指标计算改良SFS（m-SFS）：侵入性脑电图（EEG）评估（是否进行）和切除脑叶（颞叶与颞外叶），评分范围为0至6。采用Kaplan-Meier生存分析计算总体组中癫痫发作缓解的概率。使用对数秩检验和95%置信区间（CI）比较进行统计学显著性检验。
研究人群包括466例患者，其中244例（52%）为男性。癫痫发作缓解率与SFS评分直接相关：在10年时，SFS为0的患者中36.9%无癫痫发作，而SFS = 1时为45%，SFS = 2时为60%，SFS 3及以上时为72%（p = 0.002）。当计算包括IEI和定位时，评分的性能有所改善：m-SFS为0的患者中24%在10年时无癫痫发作，而m-SFS = 1 - 3时为38 - 59%，m-SFS为4 - 6时为75 - 79%（p < 0.001）。
一个易于测量的癫痫发作缓解评分可能是一种可靠的工具，可将多个癫痫发作结果预测指标综合为一个简单的评分，以预测术后癫痫发作缓解情况。该工具将有助于在手术评估的早期（SFS）和晚期（m-SFS）阶段为患者及其家属提供咨询，并评估手术候选资格。
