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@article{2398072,
author = {Ryvlin, Philippe and Barba, Carmen and Bartolomei, Fabrice and Baumgartner, Christoph and Brázdil, Milan and Fabo, Daniel and Fahoum, Firas and Frauscher, Birgit and Ikeda, Akio and Lhatoo, Samden and Mani, Jayanti and McGonigal, Aileen and Metsahonkala, EevaandLiisa and Mindruta, Ioana and Nguyen, Dang Khoa and Rheims, Sylvain and Rocamora, Rodrigo and Rydenhag, Bertil and Schuele, Stephan and SchulzeandBonhage, Andreas and Surges, Rainer and Vulliemoz, Serge and Beniczky, Sandor},
article_location = {Hoboken},
article_number = {5},
doi = {http://dx.doi.org/10.1111/epi.17928},
keywords = {confidence; Delphi; epilepsy surgery; epileptogenic zone; grading system},
language = {eng},
issn = {0013-9580},
journal = {Epilepsia},
title = {Grading system for assessing the confidence in the epileptogenic zone reported in published studies: A Delphi consensus study},
url = {https://onlinelibrary.wiley.com/doi/10.1111/epi.17928},
volume = {65},
year = {2024}
}
TY - JOUR
ID - 2398072
AU - Ryvlin, Philippe - Barba, Carmen - Bartolomei, Fabrice - Baumgartner, Christoph - Brázdil, Milan - Fabo, Daniel - Fahoum, Firas - Frauscher, Birgit - Ikeda, Akio - Lhatoo, Samden - Mani, Jayanti - McGonigal, Aileen - Metsahonkala, Eeva-Liisa - Mindruta, Ioana - Nguyen, Dang Khoa - Rheims, Sylvain - Rocamora, Rodrigo - Rydenhag, Bertil - Schuele, Stephan - Schulze-Bonhage, Andreas - Surges, Rainer - Vulliemoz, Serge - Beniczky, Sandor
PY - 2024
TI - Grading system for assessing the confidence in the epileptogenic zone reported in published studies: A Delphi consensus study
JF - Epilepsia
VL - 65
IS - 5
SP - 1346-1359
EP - 1346-1359
PB - WILEY-BLACKWELL
SN - 00139580
KW - confidence
KW - Delphi
KW - epilepsy surgery
KW - epileptogenic zone
KW - grading system
UR - https://onlinelibrary.wiley.com/doi/10.1111/epi.17928
N2 - ObjectiveThis study was undertaken to develop a standardized grading system based on expert consensus for evaluating the level of confidence in the localization of the epileptogenic zone (EZ) as reported in published studies, to harmonize and facilitate systematic reviews in the field of epilepsy surgery.MethodsWe conducted a Delphi study involving 22 experts from 18 countries, who were asked to rate their level of confidence in the localization of the EZ for various theoretical clinical scenarios, using different scales. Information provided in these scenarios included one or several of the following data: magnetic resonance imaging (MRI) findings, invasive electroencephalography summary, and postoperative seizure outcome.ResultsThe first explorative phase showed an overall interrater agreement of .347, pointing to large heterogeneity among experts' assessments, with only 17% of the 42 proposed scenarios associated with a substantial level of agreement. A majority showed preferences for the simpler scale and single-item scenarios. The successive Delphi voting phases resulted in a majority consensus across experts, with more than two thirds of respondents agreeing on the rating of each of the tested single-item scenarios. High or very high levels of confidence were ascribed to patients with either an Engel class I or class IA postoperative seizure outcome, a well-delineated EZ according to all available invasive EEG (iEEG) data, or a well-delineated focal epileptogenic lesion on MRI. MRI signs of hippocampal sclerosis or atrophy were associated with a moderate level of confidence, whereas a low level was ascribed to other MRI findings, a poorly delineated EZ according to iEEG data, or an Engel class II-IV postoperative seizure outcome.SignificanceThe proposed grading system, based on an expert consensus, provides a simple framework to rate the level of confidence in the EZ reported in published studies in a structured and harmonized way, offering an opportunity to facilitate and increase the quality of systematic reviews and guidelines in the field of epilepsy surgery.
ER -
RYVLIN, Philippe, Carmen BARBA, Fabrice BARTOLOMEI, Christoph BAUMGARTNER, Milan BRÁZDIL, Daniel FABO, Firas FAHOUM, Birgit FRAUSCHER, Akio IKEDA, Samden LHATOO, Jayanti MANI, Aileen MCGONIGAL, Eeva-Liisa METSAHONKALA, Ioana MINDRUTA, Dang Khoa NGUYEN, Sylvain RHEIMS, Rodrigo ROCAMORA, Bertil RYDENHAG, Stephan SCHUELE, Andreas SCHULZE-BONHAGE, Rainer SURGES, Serge VULLIEMOZ and Sandor BENICZKY. Grading system for assessing the confidence in the epileptogenic zone reported in published studies: A Delphi consensus study. \textit{Epilepsia}. Hoboken: WILEY-BLACKWELL, 2024, vol.~65, No~5, p.~1346-1359. ISSN~0013-9580. Available from: https://dx.doi.org/10.1111/epi.17928.
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