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Development and Validation of Prediction Models for Developmental and Intellectual Outcome Following Pediatric
Thomas Cloppenborg1, Monique van Schooneveld2, Anne Hagemann2
1From the Department of Epileptology (Krankenhaus Mara) (T.C., J.L.H., T.P., C.G.B.), Bielefeld University Medical School, Germany; Department of Pediatric Neurology (M.v.S., W.M.O., K.P.J.B.), University Medical Center Utrecht, Member of the ERN EpiCARE, the Netherlands; Society for Epilepsy Research (A.H.), Bielefeld; and Department of Neurosurgery (Evangelisches Klinikum Bethel) (T.K.), Medical School, Bielefeld University, Bielefeld, Germany. thomas.cloppenborg@mara.de.
Insights
Children undergoing epilepsy surgery have a low risk of cognitive decline. Presurgical intelligence and developmental quotients (IQ/DQ) are key predictors of postoperative outcomes, enabling better patient counseling.
Area of Science:
- Pediatric Neurology
- Neuropsychology
- Epilepsy Surgery Outcomes
Background:
- Assessing cognitive outcomes after pediatric epilepsy surgery is crucial.
- Identifying predictors of postoperative intelligence and developmental quotients (IQ/DQ) is essential for clinical practice.
Purpose of the Study:
- To identify predictors of postoperative IQ/DQ.
- To develop and validate clinically applicable IQ/DQ prediction models for children undergoing epilepsy surgery.
Main Methods:
- Retrospective analysis of neuropsychological outcomes and determinants in 492 children (IQ n=365, DQ n=127).
- Development of prediction models based on presurgical factors for dichotomized performance levels (IQ ≥85, IQ ≥70, DQ ≥50).
- External validation of IQ models and 10-fold cross-validation for DQ models.
Main Results:
- Presurgical IQ/DQ was the strongest predictor of postoperative cognition (IQ r=0.85, DQ r=0.57).
- Models demonstrated good predictive accuracy: IQ ≥85 (86%), IQ ≥70 (91%), DQ ≥50 (76%).
- External validation confirmed high accuracy and excellent discrimination for IQ prediction models.
Conclusions:
- The risk of cognitive deterioration after pediatric epilepsy surgery is low.
- Presurgical cognitive status significantly influences postoperative trajectory.
- Developed models can reliably predict cognitive outcomes, enhancing presurgical counseling for patients and parents.
Background And Objectives:
To identify predictors of postoperative intelligence and developmental quotients (IQ/DQ) and develop and validate clinically applicable IQ/DQ prediction models.
Methods:
We retrospectively analyzed neuropsychological outcomes and their possible determinants for children treated in Bethel and Utrecht since 1990. We performed separate analyses for patients with IQ and those with only DQ available. We developed prediction models based on presurgical determinants to predict dichotomized levels of performance (IQ ≥85, IQ ≥70, DQ ≥50).
Results:
IQ/DQ data before and 2 years after surgery were available for 492 patients (IQ n = 365, DQ n = 127). At a cutoff level ±10 points, the chance of improvement was considerably higher than the chance of deterioration (IQ 37.3% vs 6.6% and DQ 31.5% vs 15.0%, respectively). Presurgical IQ/DQ was the strongest predictor of postoperative cognition (IQ r = 0.85, p <0.001; DQ r = 0.57, p <0.001). Two IQ models were developed in the Bethel cohort (n = 258) and externally validated in the Utrecht cohort (n = 102). For DQ, we developed the model in the Bethel cohort and used 10-fold cross-validation. Models allowed good prediction at all 3 cutoff levels (correct classification for IQ ≥85 = 86%, IQ ≥70 = 91%, DQ ≥50 = 76%). External validation of the IQ models showed high accuracy (IQ ≥85: 0.82, confidence interval [CI] 0.75-0.91; IQ ≥70: 0.84, CI 0.77-0.92) and excellent discrimination (receiver operating characteristic curves: IQ ≥85: area under the curve [AUC] 0.90, CI 0.84-0.96; IQ ≥70: AUC 0.92, CI 0.87-0.97).
Discussion:
After epilepsy surgery in children, the risk of cognitive deterioration is very low. Presurgical development has a strong effect on the postoperative trajectory. The presented models can improve presurgical counseling of patients and parents by reliably predicting cognitive outcomes.
Classification Of Evidence:
This study provides Class II evidence that for children undergoing epilepsy surgery presurgical IQ/DQ was the strongest predictor of postoperative cognition.
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