Development and Validation of the 5-SENSE Score to Predict
Focality of the Seizure-Onset Zone as Assessed by
Stereoelectroencephalography

J 2022

Development and Validation of the 5-SENSE Score to Predict Focality of the Seizure-Onset Zone as Assessed by Stereoelectroencephalography

ASTNER-ROHRACHER, A.; G. ZIMMERMANN; T. AVIGDOR; C. ABDALLAH; N. BAROT et. al.

Basic information

Original name

Development and Validation of the 5-SENSE Score to Predict Focality of the Seizure-Onset Zone as Assessed by Stereoelectroencephalography

Authors

ASTNER-ROHRACHER, A.; G. ZIMMERMANN (guarantor); T. AVIGDOR; C. ABDALLAH; N. BAROT; Milan BRÁZDIL (203 Czech Republic, belonging to the institution); Irena DOLEŽALOVÁ (203 Czech Republic, belonging to the institution); J. GOTMAN; J. HALL; K. IKEDA; P. KAHANE; G. KALSS; V. KOKKINOS; M. LEITINGER; I. MINDRUTA; L. MINOTTI; M. M. MIZERA; I. OANE; M. RICHARDSON; S. U. SCHUELE; E. TRINKA; A. URBAN; B. WHATLEY; F. DUBEAU and B. FRAUSCHER

Edition

JAMA neurology, Chicago, IL, American Medical Association, 2022, 2168-6149

Other information

Language

English

Type of outcome

Article in a journal

Field of Study

30210 Clinical neurology

Country of publisher

United States of America

Confidentiality degree

is not subject to a state or trade secret

References:

URL

Impact factor

Impact factor: 29.000

RIV identification code

RIV/00216224:14110/22:00125189

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1001/jamaneurol.2021.4405

UT WoS

000728826400003

EID Scopus

2-s2.0-85120754390

Keywords in English

5-SENSE Score; Seizure-Onset Zone; Stereoelectroencephalography; Development; Validation

Abstract

V originále

IMPORTANCE Stereoelectroencephalography (SEEG) has become the criterion standard in case of inconclusive noninvasive presurgical epilepsy workup. However, up to 40% of patients are subsequently not offered surgery because the seizure-onset zone is less focal than expected or cannot be identified. OBJECTIVE To predict focality of the seizure-onset zone in SEEG, the 5-point 5-SENSE score was developed and validated. DESIGN, SETTING, AND PARTICIPANTS This was a monocentric cohort study for score development followed by multicenter validation with patient selection intervals between February 2002 to October 2018 and May 2002 to December 2019. The minimum follow-up period was 1 year. Patients with drug-resistant epilepsy undergoing SEEG at the Montreal Neurological Institute were analyzed to identify a focal seizure-onset zone. Selection criteria were 2 or more seizures in electroencephalography and availability of complete neuropsychological and neuroimaging data sets. For validation, patients from 9 epilepsy centers meeting these criteria were included. Analysis took place between May and July 2021. MAIN OUTCOMES AND MEASURES Based on SEEG, patients were grouped as focal and nonfocal seizure-onset zone. Demographic, clinical, electroencephalography, neuroimaging, and neuropsychology data were analyzed, and a multiple logistic regression model for developing a score to predict SEEG focality was created and validated in an independent sample. RESULTS A total of 128 patients (57 women [44.5%]; median [range] age, 31 [13-58] years) were analyzed for score development and 207 patients (97 women [46.9%]; median [range] age, 32 [16-70] years) were analyzed for validation. The score comprised the following 5 predictive variables: focal lesion on structural magnetic resonance imaging, absence of bilateral independent spikes in scalp electroencephalography, localizing neuropsychological deficit, strongly localizing semiology, and regional ictal scalp electroencephalography onset. The 5-SENSE score had an optimal mean (SD) probability cutoff for identifying a focal seizure-onset zone of 37.6 (3.5). Area under the curve, specificity, and sensitivity were 0.83, 76.3%(95% CI, 66.7-85.8), and 83.3%(95% CI, 72.30-94.1), respectively. Validation showed 76.0%(95% CI, 67.5-84.0) specificity and 52.3%(95% CI, 43.0-61.5) sensitivity. CONCLUSIONS AND RELEVANCE High specificity in score development and validation confirms that the 5-SENSE score predicts patients where SEEG is unlikely to identify a focal seizure-onset zone. It is a simple and useful tool for assisting clinicians to reduce unnecessary invasive diagnostic burden on patients and overutilization of limited health care resources.

Cite

ASTNER-ROHRACHER, A.; G. ZIMMERMANN; T. AVIGDOR; C. ABDALLAH; N. BAROT; Milan BRÁZDIL; Irena DOLEŽALOVÁ; J. GOTMAN; J. HALL; K. IKEDA; P. KAHANE; G. KALSS; V. KOKKINOS; M. LEITINGER; I. MINDRUTA; L. MINOTTI; M. M. MIZERA; I. OANE; M. RICHARDSON; S. U. SCHUELE; E. TRINKA; A. URBAN; B. WHATLEY; F. DUBEAU and B. FRAUSCHER. Development and Validation of the 5-SENSE Score to Predict Focality of the Seizure-Onset Zone as Assessed by Stereoelectroencephalography. JAMA neurology. Chicago, IL: American Medical Association, 2022, vol. 79, No 1, p. 70-79. ISSN 2168-6149. Available from: https://dx.doi.org/10.1001/jamaneurol.2021.4405.

@article{1823157,
   author = {AstnerandRohracher, A. and Zimmermann, G. and Avigdor, T. and Abdallah, C. and Barot, N. and Brázdil, Milan and Doležalová, Irena and Gotman, J. and Hall, J. and Ikeda, K. and Kahane, P. and Kalss, G. and Kokkinos, V. and Leitinger, M. and Mindruta, I. and Minotti, L. and Mizera, M. M. and Oane, I. and Richardson, M. and Schuele, S. U. and Trinka, E. and Urban, A. and Whatley, B. and Dubeau, F. and Frauscher, B.},
   article_location = {Chicago, IL},
   article_number = {1},
   doi = {http://dx.doi.org/10.1001/jamaneurol.2021.4405},
   keywords = {5-SENSE Score; Seizure-Onset Zone; Stereoelectroencephalography; Development; Validation},
   language = {eng},
   issn = {2168-6149},
   journal = {JAMA neurology},
   title = {Development and Validation of the 5-SENSE Score to Predict Focality of the Seizure-Onset Zone as Assessed by Stereoelectroencephalography},
   url = {https://jamanetwork.com/journals/jamaneurology/fullarticle/2786580},
   volume = {79},
   year = {2022}
}

TY  - JOUR
ID  - 1823157
AU  - Astner-Rohracher, A. - Zimmermann, G. - Avigdor, T. - Abdallah, C. - Barot, N. - Brázdil, Milan - Doležalová, Irena - Gotman, J. - Hall, J. - Ikeda, K. - Kahane, P. - Kalss, G. - Kokkinos, V. - Leitinger, M. - Mindruta, I. - Minotti, L. - Mizera, M. M. - Oane, I. - Richardson, M. - Schuele, S. U. - Trinka, E. - Urban, A. - Whatley, B. - Dubeau, F. - Frauscher, B.
PY  - 2022
TI  - Development and Validation of the 5-SENSE Score to Predict Focality of the Seizure-Onset Zone as Assessed by Stereoelectroencephalography
JF  - JAMA neurology
VL  - 79
IS  - 1
SP  - 70-79
EP  - 70-79
PB  - American Medical Association
SN  - 21686149
KW  - 5-SENSE Score
KW  - Seizure-Onset Zone
KW  - Stereoelectroencephalography
KW  - Development
KW  - Validation
UR  - https://jamanetwork.com/journals/jamaneurology/fullarticle/2786580
N2  - IMPORTANCE Stereoelectroencephalography (SEEG) has become the criterion standard in case of inconclusive noninvasive presurgical epilepsy workup. However, up to 40% of patients are subsequently not offered surgery because the seizure-onset zone is less focal than expected or cannot be identified. OBJECTIVE To predict focality of the seizure-onset zone in SEEG, the 5-point 5-SENSE score was developed and validated. DESIGN, SETTING, AND PARTICIPANTS This was a monocentric cohort study for score development followed by multicenter validation with patient selection intervals between February 2002 to October 2018 and May 2002 to December 2019. The minimum follow-up period was 1 year. Patients with drug-resistant epilepsy undergoing SEEG at the Montreal Neurological Institute were analyzed to identify a focal seizure-onset zone. Selection criteria were 2 or more seizures in electroencephalography and availability of complete neuropsychological and neuroimaging data sets. For validation, patients from 9 epilepsy centers meeting these criteria were included. Analysis took place between May and July 2021. MAIN OUTCOMES AND MEASURES Based on SEEG, patients were grouped as focal and nonfocal seizure-onset zone. Demographic, clinical, electroencephalography, neuroimaging, and neuropsychology data were analyzed, and a multiple logistic regression model for developing a score to predict SEEG focality was created and validated in an independent sample. RESULTS A total of 128 patients (57 women [44.5%]; median [range] age, 31 [13-58] years) were analyzed for score development and 207 patients (97 women [46.9%]; median [range] age, 32 [16-70] years) were analyzed for validation. The score comprised the following 5 predictive variables: focal lesion on structural magnetic resonance imaging, absence of bilateral independent spikes in scalp electroencephalography, localizing neuropsychological deficit, strongly localizing semiology, and regional ictal scalp electroencephalography onset. The 5-SENSE score had an optimal mean (SD) probability cutoff for identifying a focal seizure-onset zone of 37.6 (3.5). Area under the curve, specificity, and sensitivity were 0.83, 76.3%(95% CI, 66.7-85.8), and 83.3%(95% CI, 72.30-94.1), respectively. Validation showed 76.0%(95% CI, 67.5-84.0) specificity and 52.3%(95% CI, 43.0-61.5) sensitivity. CONCLUSIONS AND RELEVANCE High specificity in score development and validation confirms that the 5-SENSE score predicts patients where SEEG is unlikely to identify a focal seizure-onset zone. It is a simple and useful tool for assisting clinicians to reduce unnecessary invasive diagnostic burden on patients and overutilization of limited health care resources.
ER  -

ASTNER-ROHRACHER, A.; G. ZIMMERMANN; T. AVIGDOR; C. ABDALLAH; N. BAROT; Milan BRÁZDIL; Irena DOLEŽALOVÁ; J. GOTMAN; J. HALL; K. IKEDA; P. KAHANE; G. KALSS; V. KOKKINOS; M. LEITINGER; I. MINDRUTA; L. MINOTTI; M. M. MIZERA; I. OANE; M. RICHARDSON; S. U. SCHUELE; E. TRINKA; A. URBAN; B. WHATLEY; F. DUBEAU and B. FRAUSCHER. Development and Validation of the 5-SENSE Score to Predict Focality of the Seizure-Onset Zone as Assessed by Stereoelectroencephalography. \textit{JAMA neurology}. Chicago, IL: American Medical Association, 2022, vol.~79, No~1, p.~70-79. ISSN~2168-6149. Available from: https://dx.doi.org/10.1001/jamaneurol.2021.4405.

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