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Grading system for assessing the confidence in the epileptogenic zone reported in published studies: A Delphi
Philippe Ryvlin1, Carmen Barba2,3,4, Fabrice Bartolomei4,5
1Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois and Université de Lausanne, Lausanne, Switzerland.
Epilepsia
|February 29, 2024
Summary
A new grading system developed by experts provides a standardized way to assess confidence in identifying the epileptogenic zone (EZ) for epilepsy surgery reviews. This system harmonizes confidence levels, improving systematic reviews and guidelines.
Area of Science:
- Neurology
- Neurosurgery
- Medical Imaging
Background:
- Accurate localization of the epileptogenic zone (EZ) is crucial for successful epilepsy surgery.
- Variability in reporting confidence levels in EZ localization hinders systematic reviews and meta-analyses.
- A standardized system is needed to harmonize confidence assessments in published epilepsy studies.
Purpose of the Study:
- To develop a standardized grading system for evaluating confidence in epileptogenic zone (EZ) localization.
- To establish expert consensus on confidence levels for EZ localization based on various clinical data.
- To facilitate and improve the quality of systematic reviews and guidelines in epilepsy surgery.
Main Methods:
- A Delphi study was conducted with 22 experts from 18 countries.
- Experts rated confidence in EZ localization for theoretical clinical scenarios using different scales.
- Scenarios included magnetic resonance imaging (MRI) findings, invasive electroencephalography (iEEG) data, and postoperative seizure outcomes.
Main Results:
- Initial interrater agreement was low (.347), indicating significant heterogeneity.
- A majority of experts preferred simpler scales and single-item scenarios.
- Consensus was reached in later Delphi phases, with over two-thirds agreeing on ratings for single-item scenarios.
- High confidence was associated with favorable seizure outcomes (Engel class I/IA), clear iEEG data, or focal MRI lesions.
- Moderate confidence linked to MRI signs of hippocampal sclerosis/atrophy; low confidence to other MRI findings, unclear iEEG, or poor seizure outcomes (Engel class II-IV).
Conclusions:
- A novel, expert-consensus-based grading system offers a simple framework for rating confidence in EZ localization.
- This system standardizes and harmonizes confidence assessments in published epilepsy studies.
- The grading system is expected to enhance the quality and facilitate systematic reviews and guidelines in epilepsy surgery.
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