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Dugan, P; French, J; Carlson, C
"Surgical grading scale in the evaluation of patients with treatment resistant epilepsy" [Meeting Abstract]
Neurology 2013 12 Feb 2013; 80(1):-
OBJECTIVE: Develop a model using interictal EEG, MRI, seizure semiology, and IQ that stratifies patients with treatment resistant epilepsy based upon their likelihood of achieving seizure freedom following resective epilepsy surgery. BACKGROUND: Despite the clear role of resective surgery in treatment resistant epilepsy, no simple grading scale for neurologists exists to stratify patients based upon routinely obtained diagnostic information. In addition to providing a systematic method for predicting outcome, this instrument will allow for improved communication clinically and investigationally within this population. DESIGN/METHODS: Of the 1,105 unique presurgical admissions reviewed, 234 patients met inclusion criteria: age >=18, focal epilepsy diagnosis >=2 years, failed >=1 medication, and >=1 seizure 3 months prior to admission, presented in surgical conference (SC). The Epilepsy Surgery Grading Scale was based upon MRI, EEG, semiology, IQ. Outcomes were assessed with a minimum post-operative follow-up of 1.1 years (mean 3.9, median 4.1) and were classified as seizure free following resective surgery (SFFS), not seizure free following surgery (NSFFS), or no surgery (NS). RESULTS: Grade 1 N=77/234 (33%)-Surgery=56(72.7%): [SFFS=44(78.6%) NSFFS=12 (21.4%)] NS=21(27.3%). Grade 2 N=94/234 (40%)-Surgery=43(45.7%):[SFFS=28 (65.1%) NSFFS=15 (34.9%)]NS=51(54.3%). Grade 3 N=63/234 (26.9%)-Surgery=34(54%):[SFFS=17 (50%), NSSFS=17 (50%)]NS=29(46%). Significant differences between Grades 1 and 2 (p=0.0006) and Grades 1 and 3 (p=0.0016) were seen. CONCLUSIONS: These results indicate that basic information obtained in a doctor's office may be utilized to stratify patients with treatment resistant epilepsy into clinically meaningful groups based upon their likelihood of achieving seizure freedom. Although the initial scoring system does not strongly differentiate Grades 2&3, sub-group analyses will explore alternative scoring systems based upon these retrospective data to further improve stratification. !

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