Turkish Neurosurgery
Development and validation of a nomogram for predicting seizure outcomes after epilepsy surgery for children with focal cortical dysplasia
Yuxin Wu1, Zaiyu Zhang1, Ping Liang1, Lusheng Li1, Xuan Zhai1
1Children\'s Hospital of Chongqing Medical University, Neurosurgery, Chongqing,
DOI: 10.5137/1019-5149.JTN.40718-22.2

Aim: Focal cortical dysplasia (FCD) is the most frequent histopathology type in children with refractory epilepsy undergoing surgery. Nearly 40% of FCD patients still suffer from seizures after surgery, but currently there are no effective tools to predict postoperative outcomes in FCD children.We attempted to predict seizure outcomes after surgery to provide a tool for individualized clinical decision making and risk-adapted treatment after surgery in patients with FCD.Material and Methods:We retrospectively reviewed the clinical data of 97 children with epilepsy secondary to focal cortical dysplasia who had undergone resection surgery in the Children\'s Hospital of Chongqing Medical University from June 2013 to September 2019. Univariate and multivariate Cox proportional hazards regression were used to explore the predictors of postoperative persistent seizure, and a nomogram prediction model for postoperative seizure outcome was developed. The C-index was chosen to evaluate the discriminability of the nomogram with internal validation. Consistency and clinical efficacy were evaluated by calibration curves and decision curve analysis respectively. Results:Complete resection of epileptogenic focus and the pathological type of focal cortical dysplasia were independent predictors of persistent seizure in children with epilepsy secondary to focal cortical dysplasia after surgery. A predictive nomogram for epilepsy outcome was established based on multivariate Cox proportional hazard regression and, validated via the bootstrap method with 1000 resamples. The nomogram showed superior prediction accuracy (C-index 0.883), by drawing and reviewing the calibration curve and decision curve, the nomogram presented good consistency and clinical efficacy. Conclusion:A nomogram prediction model of postsurgery seizure outcome in children with epilepsy secondary to focal cortical dysplasia was constructed based on 4 variables, providing a reliable and convenient tool for individual seizure outcome prediction.

Corresponding author : Xuan Zhai