From the Department of Epileptology (Krankenhaus Mara) (T.C., J.L.H., T.P., C.G.B.), Bielefeld University Medical School, Germany; Department of Pediatric Neurology (M.v.S., W.M.O., K.P.J.B.), University Medical Center Utrecht, Member of the ERN EpiCARE, the Netherlands; Society for Epilepsy Research (A.H.), Bielefeld; and Department of Neurosurgery (Evangelisches Klinikum Bethel) (T.K.), Medical School, Bielefeld University, Bielefeld, Germany.
Neurology. 2022 Jan 18;98(3):e225-e235. doi: 10.1212/WNL.0000000000013065. Epub 2021 Nov 18.
To identify predictors of postoperative intelligence and developmental quotients (IQ/DQ) and develop and validate clinically applicable IQ/DQ prediction models.
We retrospectively analyzed neuropsychological outcomes and their possible determinants for children treated in Bethel and Utrecht since 1990. We performed separate analyses for patients with IQ and those with only DQ available. We developed prediction models based on presurgical determinants to predict dichotomized levels of performance (IQ ≥85, IQ ≥70, DQ ≥50).
IQ/DQ data before and 2 years after surgery were available for 492 patients (IQ n = 365, DQ n = 127). At a cutoff level ±10 points, the chance of improvement was considerably higher than the chance of deterioration (IQ 37.3% vs 6.6% and DQ 31.5% vs 15.0%, respectively). Presurgical IQ/DQ was the strongest predictor of postoperative cognition (IQ = 0.85, <0.001; DQ = 0.57, <0.001). Two IQ models were developed in the Bethel cohort (n = 258) and externally validated in the Utrecht cohort (n = 102). For DQ, we developed the model in the Bethel cohort and used 10-fold cross-validation. Models allowed good prediction at all 3 cutoff levels (correct classification for IQ ≥85 = 86%, IQ ≥70 = 91%, DQ ≥50 = 76%). External validation of the IQ models showed high accuracy (IQ ≥85: 0.82, confidence interval [CI] 0.75-0.91; IQ ≥70: 0.84, CI 0.77-0.92) and excellent discrimination (receiver operating characteristic curves: IQ ≥85: area under the curve [AUC] 0.90, CI 0.84-0.96; IQ ≥70: AUC 0.92, CI 0.87-0.97).
After epilepsy surgery in children, the risk of cognitive deterioration is very low. Presurgical development has a strong effect on the postoperative trajectory. The presented models can improve presurgical counseling of patients and parents by reliably predicting cognitive outcomes.
This study provides Class II evidence that for children undergoing epilepsy surgery presurgical IQ/DQ was the strongest predictor of postoperative cognition.
识别术后智力和发育商（IQ/DQ）的预测因子，并建立和验证临床适用的 IQ/DQ 预测模型。
我们回顾性分析了自 1990 年以来在贝塞尔和乌得勒支接受治疗的儿童的神经心理学结果及其可能的决定因素。我们对 IQ 和仅 DQ 可用的患者分别进行了分析。我们基于术前决定因素建立预测模型，以预测表现的二分水平（IQ≥85、IQ≥70、DQ≥50）。
492 名患者（IQ n=365，DQ n=127）的手术前后 IQ/DQ 数据可用。在±10 分的截定点，改善的机会明显高于恶化的机会（IQ 为 37.3%，6.6%和 DQ 为 31.5%，15.0%，分别）。术前 IQ/DQ 是术后认知的最强预测因子（IQ=0.85，<0.001；DQ=0.57，<0.001）。在贝塞尔队列（n=258）中建立了两个 IQ 模型，并在乌得勒支队列（n=102）中进行了外部验证。对于 DQ，我们在贝塞尔队列中建立了模型，并使用 10 倍交叉验证。模型在所有 3 个截定点都允许进行良好的预测（IQ≥85 的正确分类=86%，IQ≥70 的正确分类=91%，DQ≥50 的正确分类=76%）。IQ 模型的外部验证显示出较高的准确性（IQ≥85：0.82，置信区间[CI] 0.75-0.91；IQ≥70：0.84，CI 0.77-0.92）和出色的区分能力（接收者操作特征曲线：IQ≥85：曲线下面积[AUC] 0.90，CI 0.84-0.96；IQ≥70：AUC 0.92，CI 0.87-0.97）。
在儿童癫痫手术后，认知恶化的风险非常低。术前发育对术后轨迹有很强的影响。所提出的模型可以通过可靠地预测认知结果，从而改善患者和家长的术前咨询。
本研究提供了 II 级证据，表明在接受癫痫手术的儿童中，术前 IQ/DQ 是术后认知的最强预测因子。
