The long‐term surgical outcomes of <scp>low‐grade epilepsy‐associated</scp> neuroepithelial tumors

Xie, Mingguo; Xiongfei, Wang; Qiao, Jiao; Zhou, Jian; Guan, Yu-Guang; Liu, Changqing; Zhao, Meng; Li, Tianfu; Luan, Guoming

doi:10.1002/epi4.12648

Cited by 6 publications

(1 citation statement)

References 46 publications

(187 reference statements)

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“…21,24 Recently, NLP techniques allowed revealing the seizure outcome from the clinical notes. 25 In this study, we used a data-mining technique through NLP from narrative clinical reports to draw a first years natural history model of patients with DS. Our hypothesis is that this model will mimic the existing knowledge in this disease and validate this methodology as reliable source for natural history in rare and ultrarare diseases.…”

Section: Introductionmentioning

confidence: 99%

Natural history of rare diseases using natural language processing of narrative unstructured electronic health records: The example of Dravet syndrome

Lo Barco,

Garcelon,

Neuraz

et al. 2023

Epilepsia

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ObjectiveThe increasing implementation of electronic health records allows the use of advanced text‐mining methods for establishing new patient phenotypes and stratification, and for revealing outcome correlations. In this study, we aimed to explore the electronic narrative clinical reports of a cohort of patients with Dravet syndrome (DS) longitudinally followed at our center, to identify the capacity of this methodology to retrace natural history of DS during the early years.MethodsWe used a document‐based clinical data warehouse employing natural language processing to recognize the phenotype concepts in the narrative medical reports. We included patients with DS who have a medical report produced before the age of 2 years and a follow‐up after the age of 3 years (“DS cohort,” 56 individuals). We selected two control populations, a “general control cohort” (275 individuals) and a “neurological control cohort” (281 individuals), with similar characteristics in terms of gender, number of reports, and age at last report. To find concepts specifically associated with DS, we performed a phenome‐wide association study using Cox regression, comparing the reports of the three cohorts. We then performed a qualitative analysis of the surviving concepts based on their median age at first appearance.ResultsA total of 76 concepts were prevalent in the reports of children with DS. Concepts appearing during the first 2 years were mostly related with the epilepsy features at the onset of DS (convulsive and prolonged seizures triggered by fever, often requiring in‐hospital care). Subsequently, concepts related to new types of seizures and to drug resistance appeared. A series of non‐seizure‐related concepts emerged after the age of 2–3 years, referring to the nonseizure comorbidities classically associated with DS.SignificanceThe extraction of clinical terms by narrative reports of children with DS allows outlining the known natural history of this rare disease in early childhood. This original model of “longitudinal phenotyping” could be applied to other rare and very rare conditions with poor natural history description.

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Section: Introductionmentioning

confidence: 99%

Natural history of rare diseases using natural language processing of narrative unstructured electronic health records: The example of Dravet syndrome

Lo Barco,

Garcelon,

Neuraz

et al. 2023

Epilepsia

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Low‐grade epilepsy‐associated tumors: Epilepsy outcome and antiseizure medication discontinuation after lesionectomies as first‐line surgical approach in pediatric population

Bernardo,

Scala,

Rubino

et al. 2024

Epileptic Disorders

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ObjectiveThis study aimed to evaluate epilepsy outcome and antiseizure medication (ASM) discontinuation after lesionectomies as first surgical approach in pediatric population diagnosed with low‐grade epilepsy‐associated neuroepithelial tumors (LEATs).MethodsWe conducted a retrospective study. Thirty‐six consecutive patients with histological diagnoses of LEATs who underwent surgery between 2018 and 2021 at our institution were included. The clinical and surgical data were retrospectively analyzed.ResultsThirty (83.3%) of 36 patients are free of disabling seizures (Engel class I) and 19 (63,4%) of them are classified as Engel Ia. In 17 (47.2%) patients, ASM could be discontinued. The mean age at surgery was 8.6 years (±4.04) and the mean age at onset of epilepsy was 7.2 years (±3.8), whereas the mean duration of epilepsy in months at the time of surgery was 21.3 months (±23.7). The epileptogenic tumor was in the temporal lobe in 20 (55.5%) patients. Because of seizure persistence, a second or a third surgery was necessary for six patients (16.7%) and four of them had residual lesions (three in temporal and one in extratemporal site). No perioperative complications were recorded, including acute seizures, with a median hospitalization time of 7 days. Shorter epilepsy duration at time of surgery as long as a single ASM was significantly correlated with an Engel class I outcome (p‐value = .01 and p‐value = .016, respectively). Focal seizure semeiology was associated with an increased probability of antiseizure medication discontinuation (p‐value = .042).SignificanceOur findings confirm that shorter epilepsy disease duration, monotherapy before surgery, and seizure semeiology are determinant factors for a positive seizure outcome and medication discontinuation, also with less invasive surgical approaches such as lesionectomies. However, considering the intrinsic multifactorial epileptogenic nature of LEATs, a tailored surgical approach should be considered to optimize clinical and seizure outcome, especially for lesions located in the temporal lobe.

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The long‐term surgical outcomes of low‐grade epilepsy‐associated neuroepithelial tumors

et al. 2022

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Objective: This study aimed to evaluate the surgical outcomes and relevant prognostic factors in patients with low-grade epilepsy-associated neuroepithelial tumors (LEAT) and, especially, to develop a scoring system to predict postoperative seizure outcomes. Methods:The clinical data of patients who underwent epilepsy surgery for LEAT were retrospectively studied. The surgical outcomes of seizure and neurological statuses in patients were evaluated using Engel classification and modified Rankin Scale (mRS) scoring, respectively. A scoring system of seizure outcomes was constructed based on the weight of the β-coefficient estimate of each predictor in the final multivariate predicting model of seizure outcomes. Results:Of the 287 patients (106 female) enrolled, the median age was 19 years at surgery and 10 years at seizure onset, with a median duration of epilepsy of 60 months. Among 258 patients who were followed up for at least 12 months, 215 (83.3%) patients had a favorable seizure outcome (Engel class I) after surgery, and 43 (16.7%) patients had an unfavorable seizure outcome; longer duration of epilepsy, discordant magnetoencephalography (MEG) findings, and acute postoperative seizures were significantly included in the scoring system to predict unfavorable seizure outcomes, and in the scoring system, accumulated scoring of 0-19 scores was recorded, which were finally grouped into three risk levels: low risk (risk < 30%), medium risk (30% ≤ risk < 70%), and high risk (risk ≥ 70%). In addition, favorable neurological outcomes (mRS score 0-1) were recorded in 187 (72.5%) patients, while unfavorable neurological outcomes were recorded in 71 (27.5%) patients, which were significantly related to poor seizure control, older age at surgery, and longer duration of epilepsy and hospitalization time. Significance:The long-term surgical outcomes of LEAT after surgery were satisfactory. A scoring system for predicting unfavorable seizure outcomes with different risk levels was developed, which could partly guide clinical treatments of LEAT.

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The long‐term surgical outcomes of low‐grade epilepsy‐associated neuroepithelial tumors

Cited by 6 publications

References 46 publications

Natural history of rare diseases using natural language processing of narrative unstructured electronic health records: The example of Dravet syndrome

Natural history of rare diseases using natural language processing of narrative unstructured electronic health records: The example of Dravet syndrome

Low‐grade epilepsy‐associated tumors: Epilepsy outcome and antiseizure medication discontinuation after lesionectomies as first‐line surgical approach in pediatric population

The long‐term surgical outcomes of low‐grade epilepsy‐associated neuroepithelial tumors

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