New model could help identify best candidates for epilepsy surgery

Medical Xpress / Rutgers University / Annals of Clinical and Translational Neurology ^ | Oct. 8, 2024 | Andrew Smith / Adam S. Dickey et al

[ConservativeMind]

A simple scoring system from researchers at Rutgers Health and other institutions may help doctors predict which patients will likely become seizure-free after minimally invasive epilepsy surgery.

A study introduces a predictive model that could expand access to surgical treatment for the neurological disorder that causes recurring seizures.

Epilepsy affects, with roughly one-third not responding adequately to medications. For these patients, surgery to remove or disable the part of the brain causing seizures can be an effective treatment, but predicting which patients will emerge seizure-free has been difficult.

The researchers developed their model based on data from 101 patients who underwent stereotactic laser amygdalohippocampotomy (SLAH), a procedure that uses a laser (laser interstitial thermal therapy, or LITT) to target and disable a small area in the temporal lobe of the brain that causes seizures in many patients.

The researchers identified eight clinical factors associated with a higher likelihood of becoming seizure-free after the SLAH procedure. The factors include the patient's history, certain abnormalities in their MRI, lesions and febrile seizures.

Instead of relying on complex statistical models, the team created a simple ordinal score by assigning one point for each factor present. This approach outperformed other predictive models, including those based solely on MRI findings or more complex multivariate analyses.

Patients scoring 6 or higher on the 8-point scale had a 70% to 80% chance of becoming seizure-free after SLAH, comparable with success rates of conventional open surgery. Those with lower scores had progressively lower chances of a positive outcome.

Gross described using the new scoring system with a recent patient: "I was able to go to this young woman and her mother and say, 'Okay, let's look at this. You've got a 71% chance of being seizure-free.' That is a much more compelling number to tell someone than 60%."

[ConservativeMind]

According to the Abstract, this is the list of the eight scored items:

“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.”

Seizure free is a good thing to be.

[ConservativeMind]

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