Robyn M Busch1, Olivia Hogue2, Michael W Kattan2, Marla Hamberger2, Daniel L Drane2, Bruce Hermann2, Michelle Kim2, Lisa Ferguson2, William Bingaman2, Jorge Gonzalez-Martinez2, Imad M Najm2, Lara Jehi2. 1. From the Epilepsy Center (R.M.B., L.F., W.B., J.G.-M., I.M.N., L.J.), Department of Psychiatry & Psychology (R.M.B., L.F.), Department of Neurology (R.M.B., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Cleveland Clinic, OH; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (B.H.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.L.D., M.K.), University of Washington School of Medicine, Seattle. buschr@ccf.org. 2. From the Epilepsy Center (R.M.B., L.F., W.B., J.G.-M., I.M.N., L.J.), Department of Psychiatry & Psychology (R.M.B., L.F.), Department of Neurology (R.M.B., I.M.N., L.J.), Neurological Institute, and Department of Quantitative Health Sciences (O.H., M.W.K.), Cleveland Clinic, OH; Department of Neurology (M.H.), Columbia University, New York, NY; Department of Neurology and Pediatrics (D.L.D.), Emory University School of Medicine, Atlanta, GA; Department of Neurology (B.H.), University of Wisconsin School of Medicine and Public Health, Madison; and Department of Neurology (D.L.D., M.K.), University of Washington School of Medicine, Seattle.
Abstract
OBJECTIVE: To develop and externally validate models to predict the probability of postoperative naming decline in adults following temporal lobe epilepsy surgery using easily accessible preoperative clinical predictors. METHODS: In this retrospective, prediction model development study, multivariable models were developed in a cohort of 719 patients who underwent temporal lobe epilepsy surgery at Cleveland Clinic and externally validated in a cohort of 138 patients who underwent temporal lobe surgery at one of 3 epilepsy surgery centers in the United States (Columbia University Medical Center, Emory University School of Medicine, University of Washington School of Medicine). RESULTS: The development cohort was 54% female with an average age at surgery of 36 years (SD 12). Twenty-six percent of this cohort experienced clinically relevant postoperative naming decline. The model included 5 variables: side of surgery, age at epilepsy onset, age at surgery, sex, and education. When applied to the external validation cohort, the model performed very well, with excellent calibration and a c statistic (reflecting discriminatory ability) of 0.81. A second model predicting moderate to severe postoperative naming decline included 3 variables: side of surgery, age at epilepsy onset, and preoperative naming score. This model generated a c statistic of 0.84 in the external validation cohort and showed good calibration. CONCLUSION: Externally validated nomograms are provided in 2 easy-to-use formats (paper version and online calculator) clinicians can use to estimate the probability of naming decline in patients considering epilepsy surgery for treatment of pharmacoresistant temporal lobe epilepsy.
OBJECTIVE: To develop and externally validate models to predict the probability of postoperative naming decline in adults following temporal lobe epilepsy surgery using easily accessible preoperative clinical predictors. METHODS: In this retrospective, prediction model development study, multivariable models were developed in a cohort of 719 patients who underwent temporal lobe epilepsy surgery at Cleveland Clinic and externally validated in a cohort of 138 patients who underwent temporal lobe surgery at one of 3 epilepsy surgery centers in the United States (Columbia University Medical Center, Emory University School of Medicine, University of Washington School of Medicine). RESULTS: The development cohort was 54% female with an average age at surgery of 36 years (SD 12). Twenty-six percent of this cohort experienced clinically relevant postoperative naming decline. The model included 5 variables: side of surgery, age at epilepsy onset, age at surgery, sex, and education. When applied to the external validation cohort, the model performed very well, with excellent calibration and a c statistic (reflecting discriminatory ability) of 0.81. A second model predicting moderate to severe postoperative naming decline included 3 variables: side of surgery, age at epilepsy onset, and preoperative naming score. This model generated a c statistic of 0.84 in the external validation cohort and showed good calibration. CONCLUSION: Externally validated nomograms are provided in 2 easy-to-use formats (paper version and online calculator) clinicians can use to estimate the probability of naming decline in patients considering epilepsy surgery for treatment of pharmacoresistant temporal lobe epilepsy.
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