Department of Neurology, Emory University, Atlanta, Georgia, USA.
Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
Ann Clin Transl Neurol. 2024 Sep;11(9):2327-2336. doi: 10.1002/acn3.52146. Epub 2024 Jul 12.
To predict one-year seizure freedom, using a combination of relevant clinical variables, following stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy in a series of 101 patients.
Eight predictors of seizure freedom were selected based on their association with medial temporal lobe epilepsy: (1) MRI evidence of mesial temporal sclerosis (MTS); (2) unitemporal interictal epileptiform discharges; (3) absence of generalized tonic-clonic seizures; (4) history of febrile seizures; (5) onset of epilepsy ≤16 years; (6) absence of an auditory, visual, or vertiginous aura; and (7) unitemporal ictal onset; (8) unitemporal PET hypometabolism. We compared four multivariate models: "MTS," using just evidence of MTS; "FULL," using all eight binary predictors; "AIC" using backwards selection of variables; and "SCORE," using a 0-to-8-point ordinal score awarding one point for each binary predictor.
In univariate analysis, significant predictors for seizure freedom were evidence of mesial temporal sclerosis (p = 0.011, Fisher exact) and unitemporal interictal discharges (p = 0.005). For multivariate prediction (using leave one-out cross-validation), the ordinal SCORE model had a significantly higher area under the curve (AUC 0.70) than the other three models: MTS (AUC 0.54, p = 0.002, Delong's test), FULL (AUC 0.62, p = 0.003), or AIC (AUC 0.53, p < 0.001).
An ordinal score incorporating eight independent binary clinical variables predicted seizure freedom better on novel data than a model using MTS alone, a full multivariate model, or a backwards selected model. The ordinal score model represents a simple clinical heuristic to identify which patients should be offered minimally invasive laser surgery.
通过对 101 例接受立体定向激光杏仁核海马切除术的内侧颞叶癫痫患者的相关临床变量进行组合，预测其一年的无癫痫发作率。
根据与内侧颞叶癫痫的相关性，选择了 8 个无癫痫发作的预测因子：（1）MRI 证据显示存在内侧颞叶硬化（MTS）；（2）单侧间发性癫痫样放电；（3）无全身性强直阵挛性发作；（4）热性惊厥史；（5）癫痫发作起始年龄≤16 岁；（6）无听觉、视觉或眩晕先兆；（7）单侧发作起始；（8）单侧 PET 代谢低下。我们比较了四个多变量模型：“MTS”，仅使用 MTS 证据；“FULL”，使用所有 8 个二项预测因子；“AIC”，使用变量的向后选择；以及“SCORE”，使用 0 到 8 分的等级评分，为每个二项预测因子记 1 分。
在单变量分析中，无癫痫发作的显著预测因子为内侧颞叶硬化（p=0.011，Fisher 确切检验）和单侧间发性放电（p=0.005）。对于多变量预测（使用留一法交叉验证），等级 SCORE 模型的曲线下面积（AUC）显著高于其他三个模型：MTS（AUC 0.54，p=0.002，Delong 检验）、FULL（AUC 0.62，p=0.003）或 AIC（AUC 0.53，p<0.001）。
一个包含 8 个独立二项临床变量的等级评分，在新数据上对无癫痫发作的预测优于仅使用 MTS 的模型、全多变量模型或向后选择模型。等级评分模型代表了一种简单的临床启发式方法，可以识别哪些患者应接受微创激光手术。
