Testing an online screening tool for epilepsy surgery evaluation

Madeira, Bianca Cecchele; Schönwald, Suzana Veiga; Winckler, Pablo Brea; Martin, Kelin Cristine; Torres, Carolina Machado; Bizzi, Jorge Wladimir Junqueira; Bianchin, Marino Muxfeldt

doi:10.1055/s-0044-1791659

home Sumário navigate_before Anterior Atual Seguinte navigate_next

home Sumário

Original Article • Arq. Neuro-Psiquiatr. 82 (10) • 2024 • https://doi.org/10.1055/s-0044-1791659 linkcopy

Testing an online screening tool for epilepsy surgery evaluation

Testando uma ferramenta de triagem online para a avaliação de cirurgia de epilepsia

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background Epilepsy surgery is recognized for its effectiveness in controlling seizures in a significant number of patients with drug-resistant epilepsy. Despite this, there remains a notable deficiency in referring these patients for video-electroencephalogram (EEG) monitoring and surgical evaluation. Addressing this gap, the Canadian Appropriateness of Epilepsy Surgery (CASES), an online tool for epilepsy surgery evaluation (www.epilepsycases.com), was developed to aid physicians in the referral process of patients with refractory epilepsy to surgical assessments.

Objective The present study aimed to evaluate the utility of CASES in identifying candidates for epilepsy surgery, thereby facilitating clinical decision-making for patients with drug-resistant epilepsy.

Methods A cross-sectional analysis was conducted using the CASES platform to assess surgical candidacy among individuals with epilepsy. Participants were selected among those receiving care at the Epilepsy Clinic of the Neurology Service, Hospital de Clínicas de Porto Alegre, Brazil, over a 3-month period. The study cohort included 211 patients. Data were systematically extracted from patient medical records or collected during clinical appointments.

Results Of the evaluated cohort, 59.6% were identified as potential candidates for video-EEG monitoring and subsequent surgical evaluation. Factors significantly associated with recommendations for video-EEG and surgical assessment included seizure frequency, the number of antiseizure medications (ASMs) trialed, and the occurrence of drug-related adverse effects.

Conclusion The CASES showed significant potential in guiding recommendations for video-EEG monitoring and facilitating referrals for epilepsy surgery. This tool may not only enhance patient treatments and outcomes but also contribute to cost savings in epilepsy management in both the short and long term.

Keywords
Clinical Decision-Making; Health Care Costs; Electroencephalography

Variable		HISE (n = 101): n (%)	ISE (n = 19): n (%)	NISE (n = 91): n (%)	p-value
Female sex		49 (48.5%)	5 (26.3%)	49 (53.8%)	0.09
Seizure type	Focal onset aware	7 (6.9%)	1 (5.3%)	3 (3.3%)	0.5
Seizure type	Focal onset impaired awareness	94 (93.1%)	18 (94.7%)	88 (96.7%)	0.5
Seizure Frequency	None or seldom	9 (8.9%)	16 (84.2%)	84 (92.3%)	< 0.0001
	1–12 seizures/year	41 (40.6%)	3 (15.8%)	4 (4.4%)
	> 12 seizures/year	51 (50.5%)	0 (0%)	3 (3.3%)
AEDs	1	1 (1%)	1 (5.3%)	50 (54.9%)	< 0.0001
	2	32 (31.7%)	4 (21.1%)	30 (33%)
	≥ 3	68 (67.3%)	14 (73.7%)	11 (12.1%)
Drug side effects		30 (29.7%)	5 (26.3%)	5 (5.5%)	< 0.0001
Abnormal EEG		88 (87.1%)	17 (89.5%)	80 (87.9%)	0.9
Abnormal neuroimaging		68 (67.3%)	14 (73.7%)	43 (47.3%)	0.07

Variable		ISE (n = 120): n (%)	NISE (n = 91): n (%)	OR (95%CI)	p-value
Seizure type	Focal onset aware	8 (6.7%)	3 (3.3%)	2.09 (0.5–8.1)	0.3
Seizure type	Focal onset impaired awareness	112 (93.3%)	88 (96.7%)
Seizure frequency	Controlled seizures	25 (20.8%)	84 (92.3%)	45.6 (18.7–110.8)	< 0.0001
Seizure frequency	Uncontrolled seizures	95 (79.2%)	7 (7.7%)
AEDs	1	2 (1.7%)	50 (54.9%)	71.9 (16.7–308.9)	< 0.0001
AEDs	≥ 2	118 (98.3%)	41 (45.1%)
Drug side effects	Yes	35 (29.2%)	5 (5.5%)	10.0 (3.33–20.0)	< 0.0001
Drug side effects	No	85 (70.8%)	86 (94.5%)
Abnormal EEG		105 (87.5%)	80 (87.9%)	1.03 (0.4–2.3)	1.0
Abnormal neuroimaging		82 (68.3%)	43 (47.3%)	2.4 (1.3–4.2)	0.003

vertical_align_top show_chart

more_horiz close
- image
- translate
- link
- article
- vertical_align_top
- file_download
- show_chart
- image
- translate
- link
- article

location_on

Academia Brasileira de Neurologia - ABNEURO R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices Torre Norte, 04101-000 São Paulo SP Brazil, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revista.arquivos@abneuro.org

rss_feed Acompanhe os números deste periódico no seu leitor de RSS

[TFN1] Abbreviations: AEDs, antiepileptic drugs; EEG, electroencephalogram; HISE, highly indicated surgical evaluation; ISE, indicated surgical evaluation; NISE, not indicated surgical evaluation.