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Interrater reliability among epilepsy centers: multicenter study of epilepsy surgery
Sheryl R Haut1, Anne T Berg, Shlomo Shinnar
1Comprehensive Epilepsy Management Center and Departments of Neurology and Pediatrics of the Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, USA.
Epilepsia
|November 9, 2002
Summary
Epilepsy centers showed excellent agreement on resective surgery decisions and specific resection choices. However, consensus on intracranial monitoring decisions was only fair, highlighting areas for protocol improvement in epilepsy surgery evaluation.
Area of Science:
- Neurology
- Neurosurgery
- Epilepsy Research
Background:
- Epilepsy surgery requires accurate presurgical evaluation for optimal outcomes.
- Multicenter studies are crucial for establishing standardized protocols in complex neurological conditions.
- Assessing interrater reliability is key to ensuring consistent application of diagnostic and surgical decision-making processes.
Purpose of the Study:
- To evaluate the consistency of presurgical testing interpretations among different epilepsy centers.
- To measure the reliability of surgical decisions made by various epilepsy centers.
- To assess the feasibility of multicenter protocols for epilepsy management.
Main Methods:
- Seven epilepsy centers participated in a prospective multicenter study on resective epilepsy surgery.
- Each center independently reviewed 21 surgical cases for presurgical evaluation and surgical recommendations.
- Interrater reliability was quantified using intraclass correlation coefficients (ICCs) based on absolute agreement.
Main Results:
- Excellent agreement was observed for magnetic resonance imaging (MRI) and Wada lateralization/localization, and intracranial EEG localization.
- Good agreement was found for extracranial EEG localization and neuropsychological testing.
- Fair agreement was noted for the decision to perform intracranial monitoring, while overall surgical decisions showed excellent reliability.
Conclusions:
- High interrater reliability exists for most presurgical testing components in epilepsy surgery.
- While consensus on intracranial monitoring decisions needs improvement, final surgical decisions demonstrate excellent reliability.
- The study confirms the feasibility of implementing standardized multicenter protocols for epilepsy management and decision-making.