Derivation and initial validation of a surgical grading scale for the preliminary evaluation of adult patients with drug‐resistant focal epilepsy

Dugan, Patricia; Carlson, Chad; Jetté, Nathalie; Wiebe, Samuel; Bunch, Marjorie E.; Kuzniecky, Ruben; French, Jacqueline

doi:10.1111/epi.13730

Cited by 31 publications

(44 citation statements)

References 38 publications

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“…3,4 Also, our patients had tried at least three different AEDs, whereas Dugan et al included patients having failed ≥1 AED. 9 Therefore, our population was likely to be more refractory. The percentage of patients proceeding to surgery after presurgical evaluation (58.8%) was comparable.…”

Section: Discussionmentioning

confidence: 97%

“…Our patient selection procedure was slightly different from that in the original description of the ESGS. Our study consisted of two cohorts, with the presurgical cohort corresponding to the multidisciplinary conference (MDC) cohort in the original description . We included only patients undergoing a full presurgical evaluation (ie, deemed drug refractory by their treating neurologist).…”

Section: Discussionmentioning

confidence: 99%

“…Our study consisted of two cohorts, with the presurgical cohort corresponding to the multidisciplinary conference (MDC) cohort in the original description. 9 We included only patients undergoing a full presurgical evaluation (ie, deemed drug refractory by their treating neurologist). Our definition of drug refractoriness was in line with ILAE and expert recommendations and therefore did not require a minimum seizure frequency.…”

Section: Discussionmentioning

confidence: 99%

“…The ESGS score was calculated as described previously, with individual scores (IQ, seizure semiology, results of MRI and EEG) obtained from the results of presurgical evaluation. We classified patients into the three prognostic categories (grade 1, 2, or 3) based on the aggregate score obtained for each patient.…”

Section: Methodsmentioning

confidence: 99%

“…Recently, a group of experts devised a simple rating scale that assesses drug‐resistant patients’ likelihood of proceeding to resective surgery and becoming seizure‐free postsurgically . The Epilepsy Surgery Grading Scale (ESGS) is a mathematical scale, empirically derived from scores attributed to five different categories: intelligence quotient (IQ), semiology, magnetic resonance imaging (MRI), electroencephalography (EEG), and concordance between MRI and EEG (Table ).…”

Section: Introductionmentioning

confidence: 99%

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The Epilepsy Surgery Grading Scale: Validation in an independent population with drug‐resistant focal epilepsy

et al. 2019

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The Epilepsy Surgery Grading Scale (ESGS) is a simple tool that predicts a patient's likelihood of progressing to resective surgery and becoming seizure‐free. The aim of our study was to validate the ESGS in an independent patient cohort. We retrospectively calculated the ESGS score for adult patients with drug‐resistant focal epilepsy undergoing presurgical evaluation at two reference centers for drug‐resistant epilepsy in Belgium. We classified patients into ESGS grade 1 (most favorable), grade 2 (intermediate), and grade 3 (least favorable). We assessed progression to surgery and postsurgical seizure freedom. A total of 238 patients underwent presurgical evaluation (presurgical cohort), of whom 140 progressed to surgery (surgical cohort). In the presurgical cohort, we observed significant differences in rates of surgery and in rates of seizure freedom between grades 1, 2, and 3. In the surgical cohort, we observed significant differences in rates of seizure freedom between grades 1 and 2 and between grades 1 and 3. We confirm the usefulness of the ESGS for the prognostic stratification of patients with drug‐resistant focal epilepsy undergoing presurgical evaluation. Our results support the use of the ESGS in the decision process of presurgical evaluation in clinical practice.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Epilepsy Surgery Grading Scale: Validation in an independent population with drug‐resistant focal epilepsy

et al. 2019

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Focal epilepsies: Update on diagnosis and classification

Nascimento

Friedman

Peters

et al. 2023

Epileptic Disorders

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Correctly diagnosing and classifying seizures and epilepsies is paramount to ensure the delivery of optimal care to patients with epilepsy. Focal seizures, defined as those that originate within networks limited to one hemisphere, are primarily subdivided into focal aware, focal impaired awareness, and focal to bilateral tonic-clonic seizures. Focal epilepsies account for most epilepsy cases both in children and adults. In children, focal epilepsies are typically subdivided in three groups: self-limited focal epilepsy syndromes (e.g., self-limited epilepsy with centrotemporal spikes), focal epilepsy of unknown cause but which do not meet criteria for a self-limited focal epilepsy syndrome, and focal epilepsy of known cause (e.g., structural lesions-developmental or acquired). In adults, focal epilepsies are often acquired and may be caused by a structural lesion such as stroke, infection and traumatic brain injury, or brain tumors, vascular malformations, metabolic disorders, autoimmune, and/or genetic causes. In addition to seizure semiology, neuroimaging, neurophysiology, and neuropathology constitute the cornerstones of a diagnostic evaluation. Patients with focal epilepsy who become drug-resistant should promptly undergo assessment in an epilepsy center. After excluding pseudo-resistance, these patients should be considered for presurgical evaluation as a means to identify the location and extent of the epileptogenic zone and assess their candidacy for a surgical procedure. The goal of this seminar in epileptology is to summarize clinically relevant information concerning focal epilepsies. This contributes to the ILAE's mission to ensure that worldwide healthcare professionals, patients, and caregivers continue to have access to highquality educational resources concerning epilepsy.

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Epilepsy surgery in adults with intellectual disabilities

Hebel

Lindenau²

2017

Z. Epileptol.

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Derivation and initial validation of a surgical grading scale for the preliminary evaluation of adult patients with drug‐resistant focal epilepsy

Cited by 31 publications

References 38 publications

The Epilepsy Surgery Grading Scale: Validation in an independent population with drug‐resistant focal epilepsy

The Epilepsy Surgery Grading Scale: Validation in an independent population with drug‐resistant focal epilepsy

Focal epilepsies: Update on diagnosis and classification

Epilepsy surgery in adults with intellectual disabilities

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