Pediatric Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India.
Department of Radiodiagnosis and Imaging, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India.
Epilepsy Res. 2023 Nov;197:107239. doi: 10.1016/j.eplepsyres.2023.107239. Epub 2023 Oct 10.
Neurocysticercosis (NCC) is a significant factor contributing to the incidence of seizures in developing countries. While numerous studies have investigated the recurrence of seizures in NCC, their reliability is often limited.
We assessed the socio-demographic, clinical, and neuroimaging details of 161 children with seizures caused by NCC. We monitored them for seizure recurrence over a 6-month follow-up period. We divided the children into two groups: those with seizure recurrence and those without. Subsequently, we identified predictive factors associated with seizure recurrence through univariate analysis, followed by multivariate binary logistic regression. We evaluated the prognostic model for discrimination and calibration and then internally validated it using the bootstrap method.
A total of 23 children experienced breakthrough seizures. In multivariate analysis, the presence of epileptiform abnormalities in electroencephalogram (EEG), more than 5 NCC lesions, the presence of perilesional edema greater than 2 cm in maximum dimension, and a cluster of seizures before presentation were significantly associated with seizure recurrence (p < 0.05). These factors were included in the final NEPC (Number of NCC lesions, Epileptiform EEG abnormality, Perilesional edema, and Cluster of seizures) score. The final model exhibited good discrimination (AUC = 89.1 %; 95 % CI=80.5-95.3 %, p < 0.001) and calibration (p = 0.54). A score of 4 appeared to be the optimal threshold for discriminating between individuals with and without seizure recurrence, with sensitivity and specificity values of 85 % and 87 %, respectively. Interrater reliability was very strong between two pediatric neurologists and strong between a pediatric neurologist and a pediatric neurology trainee resident (k = 0.92 and 0.86, respectively).
The NEPC score demonstrates good sensitivity and specificity in predicting seizure recurrence in pediatric children with NCC.
神经囊虫病（NCC）是发展中国家癫痫发作的重要因素。虽然有许多研究调查了 NCC 患者癫痫发作的复发情况，但它们的可靠性往往有限。
我们评估了 161 例由 NCC 引起的癫痫发作儿童的社会人口统计学、临床和神经影像学细节。我们对他们进行了 6 个月的随访，以监测癫痫发作的复发情况。我们将儿童分为两组：有复发组和无复发组。随后，我们通过单因素分析确定与癫痫发作复发相关的预测因素，然后通过多元二项逻辑回归进行分析。我们评估了预测模型的区分度和校准度，然后使用 bootstrap 方法进行内部验证。
共有 23 例儿童出现突破性癫痫发作。在多因素分析中，脑电图（EEG）存在痫样异常、有超过 5 个 NCC 病变、最大径线的病变周围水肿大于 2cm，以及发作前出现簇状发作与癫痫发作复发显著相关（p<0.05）。这些因素被纳入最终的 NEPC（NCC 病变数量、EEG 痫样异常、病变周围水肿和发作簇）评分。最终模型具有良好的区分度（AUC=89.1%；95%CI=80.5-95.3%，p<0.001）和校准度（p=0.54）。评分 4 似乎是区分有无癫痫发作复发的最佳阈值，敏感性和特异性分别为 85%和 87%。两位儿科神经科医生之间的组内一致性非常强，儿科神经科医生和儿科神经科住院医师之间的组内一致性也很强（k 值分别为 0.92 和 0.86）。
NEPC 评分在预测小儿 NCC 患者癫痫发作复发方面具有良好的敏感性和特异性。
