open access publication

Article, Early Access, 2024

Grading system for assessing the confidence in the epileptogenic zone reported in published studies: A Delphi consensus study

EPILEPSIA, ISSN 0013-9580, 0013-9580, 10.1111/epi.17928

Contributors

Ryvlin, Philippe (Corresponding author) [1] [2] Barba, Carmen [3] [4] [5] Bartolomei, F. [5] [6] [7] Baumgartner, Christoph [5] [8] [9] Brazdil, Milan 0000-0001-7979-2343 [5] [10] [11] Fabo, Daniel [12] Fahoum, Firas 0000-0003-2262-5530 [13] [14] Frauscher, B. [15] Ikeda, Akio [16] Lhatoo, Samden [17] [18] Mani, Jayanti [19] McGonigal, A. [20] Metsahonkala, Eeva-Liisa [5] [21] [22] Mindruta, Ioana [5] [23] [24] Nguyen, Dang Khoa 0000-0002-7016-601X [25] Rheims, Sylvain 0000-0002-4663-8515 [5] [26] [27] Rocamora, Rodrigo [5] [28] [29] [30] Rydenhag, Bertil 0000-0001-8472-5313 [5] [31] [32] Schuele, Stephan [33] Schulze-Bonhage, Andreas [5] [34] Surges, Rainer [5] [35] Vulliemoz, Serge [36] Beniczky, Sandor [5] [37] [38]

Affiliations

  1. [1] CHU Vaudois, Dept Clin Neurosci, Lausanne, Switzerland
    2. [NORA names: Switzerland; Europe, Non-EU; OECD];
  2. [2] CHU Vaudois, Dept Clin Neurosci, Lausanne, Switzerland
    3. [NORA names: Switzerland; Europe, Non-EU; OECD];
  3. [3] Meyer Childrens Hosp IRCCS, Neurosci Dept, Florence, Italy
    4. [NORA names: Italy; Europe, EU; OECD];
  4. [4] Univ Florence, Florence, Italy
    5. [NORA names: Italy; Europe, EU; OECD];
  5. [5] ERN EpiCARE, Gothenburg, Sweden
    6. [NORA names: Sweden; Europe, EU; Nordic; OECD];

Abstract

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.

Keywords

Delphi, confidence, epilepsy surgery, epileptogenic zone, grading system

Data Provider: Clarivate

LINKS
-

Matching Records in NORA

SUBJECTS
+

METRICS
+