Could This Bring Epilepsy Surgery into the 21st Century?

Posted in Research and Development by amanda.pedersen on June 30, 2017

Researchers from Cleveland Clinic, Mayo Clinic, and the University of Campinas in Brazil, will use a $3.4 million NIH grant to develop a comprehensive risk calculator to determine which patients will most benefit from epilepsy surgery.

Amanda Pedersen

Researchers are working on a risk calculator, known as an epilepsy surgery nomogram, that could offer an individualized prediction of surgery outcomes for patients with drug-resistant epilepsy.

 

A $3.4 million grant is expected to help a multi-center research team develop a tool to predict individual outcomes in epilepsy surgery, which the researchers say would bring patient counseling into the 21st century and expand it beyond a doctor's best-educated opinion to a more scientific-based approach.

The National Institutes of Health grant, led by Cleveland Clinic's Lara Jehi, MD, will support the creation of an epilepsy surgery nomogram (ESN) using diagnostic technology and predictive modeling. The project is a five-year collaboration between the Cleveland Clinic Neurological Institute's Epilepsy Center and the Cleveland Clinic Lerner Research Institute's Quantitative Health Sciences team with Mayo Clinic and the University of Campinas. The study will incorporate robust patient data into a risk calculator known as a nomogram to better determine which patients will most benefit from the procedure.

"The typical current path to epilepsy surgery reveals the unquestionable need for process improvements that could be fostered by a tool like the ESN," said Jehi, research director of the Cleveland Clinic Epilepsy Center. “Patients now hear the ‘average’ chance of success with this brain surgery, but do not know what their individual chance of success is: ‘How did a patient like me do with this procedure?’ The nomogram will enable us to bring patient counseling into the 21s century and expand it beyond our best-educated opinion to actual science."

Jehi said the new tool will "arm physicians" with the ability to better select optimal surgical candidates and estimate the likelihood of seizure freedom after epilepsy surgery. This type of surgery is a treatment option for drug-resistant epilepsy but currently remains underused due to multiple factors, including the inability to predict individualized outcomes following surgery. The clinic noted that patients undergo sophisticated testing to determine the area of the brain triggering the seizures, but the decision to initiate this workup, and the final choice to do the procedure, are subjective and variable.

The grant will allow the multi-center research team to build on its first ESN, which used basic clinical patient characteristics, such as age, gender, and seizure frequency, to provide an objective, individualized prediction of postoperative seizure outcomes at two and five years after the surgery. The first nomogram and its initial retrospective validation were recently published in Lancet Neurology.

The researchers said the new, enhanced risk calculator will factor in additional clinical, imaging, genetic, electrophysiological, and histopathological data. The comprehensive ESN will be developed from a retrospective cohort of 450 patients from Cleveland Clinic, Mayo Clinic, and the University of Campinas. The new tool will also be prospectively validated in 250 patients from the same centers.

"When completed, this project will generate the first objective, validated, user-friendly epilepsy surgery prediction tool," Jehi said. "We will learn from the collective experience of thousands of patients. Instead of each physician working on an island, we can synthesize data and pull it all together to make more strategic predictions using a much more scientific decision-making process."

Achieving this goal, she said, will improve patient counseling and benefit public health.

"The development of risk prediction calculators like the ESN is vital for improving medical decision-making," said Michael Kattan, PhD, chair of Quantitative Health Sciences at Cleveland Clinic. Kattan pioneered the nomogram concept, and his risk calculators have been applied to many diseases, including coronary artery disease, cancer, type 2 diabetes, and total joint replacements.

Amanda Pedersen is Qmed's news editor. Contact her at amanda.pedersen@ubm.com.

 

[Image credit: Cleveland Clinic]