Multimodal prognostic features of seizure freedom in epilepsy surgery
ObjectiveAccurate preoperative predictions of seizure freedom following surgery for focal drug resistant epilepsy remain elusive. Our objective was to systematically evaluate all meta-analyses of epilepsy surgery with seizure freedom as the primary outcome, to identify clinical features that are con...
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| Published in: | Journal of neurology, neurosurgery and psychiatry Vol. 93; no. 5; pp. 499 - 508 |
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| Main Authors: | , , |
| Format: | Journal Article |
| Language: | English |
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England
BMJ Publishing Group Ltd
01.05.2022
BMJ Publishing Group LTD BMJ Publishing Group |
| Series: | Original research |
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| ISSN: | 0022-3050, 1468-330X, 1468-330X |
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| Abstract | ObjectiveAccurate preoperative predictions of seizure freedom following surgery for focal drug resistant epilepsy remain elusive. Our objective was to systematically evaluate all meta-analyses of epilepsy surgery with seizure freedom as the primary outcome, to identify clinical features that are consistently prognostic and should be included in the future models.MethodsWe searched PubMed and Cochrane using free-text and Medical Subject Heading (MeSH) terms according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. This study was registered on PROSPERO. We classified features as prognostic, non-prognostic and uncertain and into seven subcategories: ‘clinical’, ‘imaging’, ‘neurophysiology’, ‘multimodal concordance’, ‘genetic’, ‘surgical technique’ and ‘pathology’. We propose a structural causal model based on these features.ResultsWe found 46 features from 38 meta-analyses over 22 years. The following were consistently prognostic across meta-analyses: febrile convulsions, hippocampal sclerosis, focal abnormal MRI, Single-Photon Emission Computed Tomography (SPECT) coregistered to MRI, focal ictal/interictal EEG, EEG-MRI concordance, temporal lobe resections, complete excision, histopathological lesions, tumours and focal cortical dysplasia type IIb. Severe learning disability was predictive of poor prognosis. Others, including sex and side of resection, were non-prognostic. There were limited meta-analyses investigating genetic contributions, structural connectivity or multimodal concordance and few adjusted for known confounders or performed corrections for multiple comparisons.SignificanceSeizure-free outcomes have not improved over decades of epilepsy surgery and despite a multitude of models, none prognosticate accurately. Our list of multimodal population-invariant prognostic features and proposed structural causal model may serve as an objective foundation for statistical adjustments of plausible confounders for use in high-dimensional models.PROSPERO registration numberCRD42021185232. |
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| AbstractList | Accurate preoperative predictions of seizure freedom following surgery for focal drug resistant epilepsy remain elusive. Our objective was to systematically evaluate all meta-analyses of epilepsy surgery with seizure freedom as the primary outcome, to identify clinical features that are consistently prognostic and should be included in the future models.
We searched PubMed and Cochrane using free-text and Medical Subject Heading (MeSH) terms according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. This study was registered on PROSPERO. We classified features as prognostic, non-prognostic and uncertain and into seven subcategories: 'clinical', 'imaging', 'neurophysiology', 'multimodal concordance', 'genetic', 'surgical technique' and 'pathology'. We propose a structural causal model based on these features.
We found 46 features from 38 meta-analyses over 22 years. The following were consistently prognostic across meta-analyses: febrile convulsions, hippocampal sclerosis, focal abnormal MRI, Single-Photon Emission Computed Tomography (SPECT) coregistered to MRI, focal ictal/interictal EEG, EEG-MRI concordance, temporal lobe resections, complete excision, histopathological lesions, tumours and focal cortical dysplasia type IIb. Severe learning disability was predictive of poor prognosis. Others, including sex and side of resection, were non-prognostic. There were limited meta-analyses investigating genetic contributions, structural connectivity or multimodal concordance and few adjusted for known confounders or performed corrections for multiple comparisons.
Seizure-free outcomes have not improved over decades of epilepsy surgery and despite a multitude of models, none prognosticate accurately. Our list of multimodal population-invariant prognostic features and proposed structural causal model may serve as an objective foundation for statistical adjustments of plausible confounders for use in high-dimensional models.
CRD42021185232. ObjectiveAccurate preoperative predictions of seizure freedom following surgery for focal drug resistant epilepsy remain elusive. Our objective was to systematically evaluate all meta-analyses of epilepsy surgery with seizure freedom as the primary outcome, to identify clinical features that are consistently prognostic and should be included in the future models.MethodsWe searched PubMed and Cochrane using free-text and Medical Subject Heading (MeSH) terms according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. This study was registered on PROSPERO. We classified features as prognostic, non-prognostic and uncertain and into seven subcategories: ‘clinical’, ‘imaging’, ‘neurophysiology’, ‘multimodal concordance’, ‘genetic’, ‘surgical technique’ and ‘pathology’. We propose a structural causal model based on these features.ResultsWe found 46 features from 38 meta-analyses over 22 years. The following were consistently prognostic across meta-analyses: febrile convulsions, hippocampal sclerosis, focal abnormal MRI, Single-Photon Emission Computed Tomography (SPECT) coregistered to MRI, focal ictal/interictal EEG, EEG-MRI concordance, temporal lobe resections, complete excision, histopathological lesions, tumours and focal cortical dysplasia type IIb. Severe learning disability was predictive of poor prognosis. Others, including sex and side of resection, were non-prognostic. There were limited meta-analyses investigating genetic contributions, structural connectivity or multimodal concordance and few adjusted for known confounders or performed corrections for multiple comparisons.SignificanceSeizure-free outcomes have not improved over decades of epilepsy surgery and despite a multitude of models, none prognosticate accurately. Our list of multimodal population-invariant prognostic features and proposed structural causal model may serve as an objective foundation for statistical adjustments of plausible confounders for use in high-dimensional models.PROSPERO registration numberCRD42021185232. Accurate preoperative predictions of seizure freedom following surgery for focal drug resistant epilepsy remain elusive. Our objective was to systematically evaluate all meta-analyses of epilepsy surgery with seizure freedom as the primary outcome, to identify clinical features that are consistently prognostic and should be included in the future models.OBJECTIVEAccurate preoperative predictions of seizure freedom following surgery for focal drug resistant epilepsy remain elusive. Our objective was to systematically evaluate all meta-analyses of epilepsy surgery with seizure freedom as the primary outcome, to identify clinical features that are consistently prognostic and should be included in the future models.We searched PubMed and Cochrane using free-text and Medical Subject Heading (MeSH) terms according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. This study was registered on PROSPERO. We classified features as prognostic, non-prognostic and uncertain and into seven subcategories: 'clinical', 'imaging', 'neurophysiology', 'multimodal concordance', 'genetic', 'surgical technique' and 'pathology'. We propose a structural causal model based on these features.METHODSWe searched PubMed and Cochrane using free-text and Medical Subject Heading (MeSH) terms according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. This study was registered on PROSPERO. We classified features as prognostic, non-prognostic and uncertain and into seven subcategories: 'clinical', 'imaging', 'neurophysiology', 'multimodal concordance', 'genetic', 'surgical technique' and 'pathology'. We propose a structural causal model based on these features.We found 46 features from 38 meta-analyses over 22 years. The following were consistently prognostic across meta-analyses: febrile convulsions, hippocampal sclerosis, focal abnormal MRI, Single-Photon Emission Computed Tomography (SPECT) coregistered to MRI, focal ictal/interictal EEG, EEG-MRI concordance, temporal lobe resections, complete excision, histopathological lesions, tumours and focal cortical dysplasia type IIb. Severe learning disability was predictive of poor prognosis. Others, including sex and side of resection, were non-prognostic. There were limited meta-analyses investigating genetic contributions, structural connectivity or multimodal concordance and few adjusted for known confounders or performed corrections for multiple comparisons.RESULTSWe found 46 features from 38 meta-analyses over 22 years. The following were consistently prognostic across meta-analyses: febrile convulsions, hippocampal sclerosis, focal abnormal MRI, Single-Photon Emission Computed Tomography (SPECT) coregistered to MRI, focal ictal/interictal EEG, EEG-MRI concordance, temporal lobe resections, complete excision, histopathological lesions, tumours and focal cortical dysplasia type IIb. Severe learning disability was predictive of poor prognosis. Others, including sex and side of resection, were non-prognostic. There were limited meta-analyses investigating genetic contributions, structural connectivity or multimodal concordance and few adjusted for known confounders or performed corrections for multiple comparisons.Seizure-free outcomes have not improved over decades of epilepsy surgery and despite a multitude of models, none prognosticate accurately. Our list of multimodal population-invariant prognostic features and proposed structural causal model may serve as an objective foundation for statistical adjustments of plausible confounders for use in high-dimensional models.SIGNIFICANCESeizure-free outcomes have not improved over decades of epilepsy surgery and despite a multitude of models, none prognosticate accurately. Our list of multimodal population-invariant prognostic features and proposed structural causal model may serve as an objective foundation for statistical adjustments of plausible confounders for use in high-dimensional models.CRD42021185232.PROSPERO REGISTRATION NUMBERCRD42021185232. |
| Author | Vakharia, Vejay Niranjan Duncan, John Sidney Alim-Marvasti, Ali |
| Author_xml | – sequence: 1 givenname: Ali orcidid: 0000-0002-7811-0344 surname: Alim-Marvasti fullname: Alim-Marvasti, Ali email: marvasti@nhs.net organization: Wellcome/EPSRC Centre for Interventional and Surgical Sciences, Department of Medical Physics and Biomedical Engineering, University College London, London, UK – sequence: 2 givenname: Vejay Niranjan orcidid: 0000-0002-9476-4225 surname: Vakharia fullname: Vakharia, Vejay Niranjan organization: Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London Faculty of Brain Sciences, London, UK – sequence: 3 givenname: John Sidney surname: Duncan fullname: Duncan, John Sidney organization: Department of Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London Faculty of Brain Sciences, London, UK |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/35246493$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1002_epi4_12795 crossref_primary_10_1038_s41598_024_60622_5 crossref_primary_10_1007_s00259_024_06656_3 crossref_primary_10_1016_j_seizure_2023_01_019 crossref_primary_10_1111_epi_17559 crossref_primary_10_1016_j_neuroimage_2024_120682 crossref_primary_10_1097_WNP_0000000000001012 crossref_primary_10_1016_j_yebeh_2024_110247 crossref_primary_10_1016_j_yebeh_2025_110518 crossref_primary_10_1186_s42494_024_00190_3 crossref_primary_10_1111_epi_18353 crossref_primary_10_1111_epi_18443 crossref_primary_10_1002_acn3_52146 crossref_primary_10_1038_s41467_024_49470_z crossref_primary_10_1177_15357597221101271 crossref_primary_10_1038_s41582_024_00965_9 crossref_primary_10_1136_bmjopen_2022_065440 crossref_primary_10_3389_fneur_2024_1419104 crossref_primary_10_1016_j_seizure_2023_11_005 crossref_primary_10_1212_WNL_0000000000209304 crossref_primary_10_3389_fpsyt_2022_966721 crossref_primary_10_52645_MJHS_2023_4_02 crossref_primary_10_1016_j_neurol_2023_02_067 |
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| Keywords | meta-analysis neurosurgery epilepsy, surgery |
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| PublicationTitle | Journal of neurology, neurosurgery and psychiatry |
| PublicationTitleAbbrev | J Neurol Neurosurg Psychiatry |
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| Snippet | ObjectiveAccurate preoperative predictions of seizure freedom following surgery for focal drug resistant epilepsy remain elusive. Our objective was to... Accurate preoperative predictions of seizure freedom following surgery for focal drug resistant epilepsy remain elusive. Our objective was to systematically... |
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| StartPage | 499 |
| SubjectTerms | Bias Collaboration Convulsions & seizures Drug resistance Drug Resistant Epilepsy - surgery Electroencephalography Epilepsy Epilepsy - diagnosis Epilepsy - surgery Freedom Humans Machine learning Magnetic Resonance Imaging Medical prognosis Meta-analysis Meta-Analysis as Topic neurosurgery Patients Prognosis Retrospective Studies Seizures Semiotics Surgery Surgical mesh Surgical outcomes Tomography, Emission-Computed, Single-Photon Treatment Outcome Variables Variance analysis |
| Title | Multimodal prognostic features of seizure freedom in epilepsy surgery |
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