Development and validation of nomograms to provide individualised predictions of seizure outcomes after epilepsy surgery: a retrospective analysis.

摘要: Summary Background Half of patients who have resective brain surgery for drug-resistant epilepsy recurrent postoperative seizures. Although several single predictors seizure outcome been identified, no validated method incorporates a patient's complex clinical characteristics into an instrument to predict individual's post-surgery outcome. Methods We developed nomograms complete freedom from seizures and Engel score 1 (eventual allowing some initial seizures, or occurring only with physiological stress such as drug withdrawal) at 2 years 5 after on the basis sex, frequency, secondary generalisation, type surgery, pathological cause, age onset, duration time surgical side. designed models development cohort had Cleveland Clinic (Cleveland, OH, USA) between 1996 2011. then tested in external validation operated over similar period four centres, Brazil, France, Italy, USA. assessed performance nomogram by calculating concordance statistics assessing calibration predicted reported 1. Findings The included 846 604 patients. Variables were cause. In cohort, baseline risk was 0·57 0·40 years. 0·69 0·62 statistic 0·60 0·61 Calibration curves showed adequate (judged eye) throughout range outcomes. Interpretation If prospective cohorts, these could be used outcomes judged eligible surgery. Funding Epilepsy Center.