Predicting mood decline following temporal lobe epilepsy surgery in adults.
Predicting mood decline following temporal lobe epilepsy surgery in adults.
复制标题
预测成人颞叶癫痫手术后情绪下降。
作者：
Doherty C;Nowacki AS;Pat McAndrews M;McDonald CR;Reyes A;Kim MS;Hamberger M;Najm I;Bingaman W;Jehi L;Busch RM
建立一个模型来预测颞叶切除术治疗耐药性癫痫后成人情绪下降的概率。使用最佳子集回归对克利夫兰诊所的492例患者进行变量选择。在完成变量选择后，从北美的四个癫痫手术中心（N = 100）请求一个变量子集。将所有数据合并以开发预测术后情绪下降的最终模型（N = 592）。使用bootstrap重新启动进行了内部确认。抑郁症状的临床显著增加定义为贝克抑郁量表-第二版（BDI-II）评分增加15%且术后原始评分>11。克利夫兰诊所队列中14%的患者和外部队列中22%的患者在手术后出现临床显著的抑郁症状增加。最终的预测模型包括6个预测变量：精神病史、切除侧、关系状态、语言流畅性评分、术前测试时的年龄和MRI上是否存在皮质发育畸形。该模型具有0.70的乐观调整c-统计量和良好的校准，在较高风险患者中具有轻微的高估概率。临床医生可以通过纸质工具或在线计算器使用我们的列线图来估计TLE手术前个体患者术后情绪下降的风险。
To develop a model to predict the probability of mood decline in adults following temporal lobe resection for the treatment of pharmacoresistant epilepsy. Variable selection was performed on 492 patients from the Cleveland Clinic using best subsets regression. After completing variable selection, a subset of variables was requested from four epilepsy surgery centers across North America (N = 100). All data was combined to develop a final model to predict postoperative mood decline (N = 592). Internal validation with bootstrap resampling was performed. A clinically significant increase in depressive symptoms was defined as a 15% increase in Beck Depression Inventory – Second Edition (BDI-II) score and a post-operative raw score >11. Fourteen percent of patients in the Cleveland Clinic cohort, and twenty-two percent of patients in the external cohort experienced clinically significant increases in depressive symptoms following surgery. The final prediction model included six predictor variables: psychiatric history, resection side, relationship status, verbal fluency score, age at preoperative testing, and presence/absence of malformation of cortical development on MRI. The model had an optimism adjusted c-statistic of 0.70 and good calibration, with slight probability of overestimation in higher risk patients. Clinicians can utilize our nomogram via a paper tool or online calculator to estimate the risk of postoperative mood decline for individual patients prior to TLE surgery.
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