The National Institutes of Health has awarded a $3.4 million grant to a Cleveland Clinic-led research collaboration whose objective is to come up with a more comprehensive model for predicting epilepsy surgery outcomes.
Dr. Lara Jehi of the Cleveland Clinic, who received the grant, will head the multi-center research team’s effort to develop an updated version of a predictive tool known as a nomogram. The work will build on a model that a Cleveland Clinic researcher originally developed.
The research team will use medical records of 450 patients in their study. It will come from the collaborating centers: the Mayo Clinic, the University of Campinas in Brazil, the Neurological Institute’s Epilepsy Center and the Lerner Research Institute’s Department of Quantitative Health Sciences.
Researchers will use the records to develop a surgical risk model that doctors can use to predict which patients would benefit the most from an operation. The team will try to validate the model in 250 patients from the same centers.
“The development of risk prediction calculators like the ESN [epilepsy surgery nomogram] is vital for improving medical decision-making,” Dr. Michael Kattan, the Cleveland Clinic researcher who pioneered the nomogram concept, said in a press release. “Tools like this represent another step toward personalized medicine that will ultimately improve efficiency, outcomes and patient care.”
Kattan developed the risk calculators to help physicians make better decisions about patient care. They have been used in many disorders, including coronary artery disease, certain cancers, and type 2 diabetes.
“The typical current path to epilepsy surgery reveals the unquestionable need for process improvements that could be fostered by a tool like the ESN,” said Jehi, the research director of the Cleveland Clinic Epilepsy Center.
Patients hear about the average chance of the brain surgery’s success, “but do not know what their individual chance of success is,” she said. They want to know how would “a patient like me do with this procedure? The nomogram will enable us to bring patient counseling into the 21st century and expand it beyond our best educated opinion to actual science. It will arm physicians with an advanced statistical tool to better select optimal surgical candidates and estimate the likelihood of seizure freedom [lack of seizures] after epilepsy surgery.”
Many drug-resistant epilepsy patients consider surgery the next option but the treatment is underused because doctors are unable to predict an outcome from patient to patient. This has led to relatively few patients opting for surgery.
The research team will build on the nomogram Kattan developed for epileptic surgery. The original used characteristics such as patients’ age and gender and the frequency of their seizures.
Researchers will use the new grant to create an enhanced risk calculator. In addition to Kattan’s reference points, it will include patients’ disease history, brain imaging results, genetic testing, electrical properties of cells and tissue, and tissue changes that epilepsy has caused.
“When completed, this project will generate the first objective, validated, user-friendly epilepsy surgery prediction tool,” Jehi said. “We will learn from the collective experience of thousands of patients. Instead of each physician working on an island, we can synthesize data and pull it all together to make more strategic predictions using a much more scientific decision-making process. Achieving this goal will improve patient counseling and benefit public health.”