Lukmanji Sara, Altura K Chelsea, Rydenhag Bertil, Malmgren Kristina, Wiebe Samuel, Jetté Nathalie
Department of Clinical Neurosciences, University of Calgary, 1403 29 Street NW, Calgary, Alberta, T2N2T9, Canada; Hotchkiss Brain Institute, University of Calgary, 1403 29 Street NW, Calgary, Alberta, T2N2T9, Canada.
Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, Blå Stråket 7, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden.
Epilepsy Res. 2018 Sep;145:140-144. doi: 10.1016/j.eplepsyres.2018.06.014. Epub 2018 Jun 28.
The Canadian Appropriateness of Epilepsy Surgery (CASES) tool was developed to help physicians identify patients who should be referred for an epilepsy surgery evaluation. The aim of this study was to determine the accuracy of this tool using a population-based cohort registry (the Swedish National Epilepsy Surgery Register) of patients who underwent epilepsy surgery between 1990 and 2012.
Overall, 1044 patients met eligibility criteria for the study and were deemed to be surgical candidates by epilepsy experts. Demographic and epilepsy related characteristics were examined and summarized using descriptive statistics. A CASES appropriateness score was calculated for each of these patients. Chi squared analyses or fisher's exact tests were used to determine if there were any relationships between demographic and epilepsy related characteristics not captured in the tool and appropriateness scores.
The mean appropriateness score was 8.6 and 985 (Sensitivity: 94.35%; 95% CI, 92.77%-95.60%) patients were appropriate, 46 (4.41%; 95% CI, 3.31%-5.84%) were uncertain, and 13 (1.25%; 95% CI, 0.72%-2.13%) were inappropriate for an epilepsy surgery evaluation. The mean necessity score, which was only calculated for the 985 appropriate patients, was 8.7. All 13 inappropriate patients had tried less than two anti-epileptic drugs (AEDs). In addition, age at onset of epilepsy and age at epilepsy surgery were both significantly associated with appropriateness score.
These results demonstrate that the CASES tool is highly sensitive as it designated 94.3% of epilepsy surgery patients as appropriate for an epilepsy surgery evaluation. All of those classified as inappropriate were not drug resistant, as they had not yet tried two AEDs.
开发加拿大癫痫手术适宜性（CASES）工具，以帮助医生识别应转介进行癫痫手术评估的患者。本研究的目的是使用基于人群的队列登记库（瑞典国家癫痫手术登记库）来确定该工具在1990年至2012年间接受癫痫手术的患者中的准确性。
总体而言，1044名患者符合研究的纳入标准，并被癫痫专家视为手术候选者。使用描述性统计方法对人口统计学和癫痫相关特征进行检查和总结。为这些患者中的每一位计算CASES适宜性评分。使用卡方分析或费舍尔精确检验来确定该工具未涵盖的人口统计学和癫痫相关特征与适宜性评分之间是否存在任何关系。
平均适宜性评分为8.6，985名患者（敏感性：94.35%；95%置信区间，92.77%-95.60%）适宜进行癫痫手术评估，46名患者（4.41%；95%置信区间，3.31%-5.84%）不确定，13名患者（1.25%；95%置信区间，0.72%-2.13%）不适宜进行癫痫手术评估。仅为985名适宜患者计算的平均必要性评分为8.7。所有13名不适宜患者尝试的抗癫痫药物（AEDs）均少于两种。此外，癫痫发作起始年龄和癫痫手术年龄均与适宜性评分显著相关。
这些结果表明，CASES工具具有高度敏感性，因为它将94.3%的癫痫手术患者判定为适宜进行癫痫手术评估。所有被归类为不适宜的患者均非耐药患者，因为他们尚未尝试两种AEDs。
