Analysis in risk factors of postoperative recurrence of patients with refractory epilepsy and establishment of a risk prediction model

LIU Haijia; CHEN Ming; LI Yanzhen

doi:10.7619/jcmp.20240080

Journal of Clinical Medicine in Practice > 2024 > 28(8): 7-11. > DOI: 10.7619/jcmp.20240080

LIU Haijia, CHEN Ming, LI Yanzhen. Analysis in risk factors of postoperative recurrence of patients with refractory epilepsy and establishment of a risk prediction model[J]. Journal of Clinical Medicine in Practice, 2024, 28(8): 7-11. DOI: 10.7619/jcmp.20240080

Citation:

PDF (848 KB)

Analysis in risk factors of postoperative recurrence of patients with refractory epilepsy and establishment of a risk prediction model

Department of Neurosurgery, Xinhua Hospital Affiliated to School of Medicine of Shanghai Jiao Tong University, Shanghai, 200092

More Information

Received Date: January 03, 2024
Revised Date: March 05, 2024
Available Online: May 05, 2024

Graphical Abstract

Abstract

Abstract

Objective
To explore the risk factors for postoperative recurrence in patients with refractory epilepsy and establish a predictive model.
Methods
Clinical materials of 280 refractory epilepsy patients with surgical treatment in the hospital from June 2021 to October 2022 were retrospectively collected, with a follow-up of one year after surgery. These patients were divided into non-recurrence group with 238 cases and recurrence group with 42 cases according to their recurrence status. The risk factors for postoperative recurrence in refractory epilepsy patients were analyzed by univariate and multivariate Logistic regression analyses; the receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of the model for postoperative recurrence in refractory epilepsy patients.
Results
Multivariate Logistic regression analysis showed that disease duration exceeding 5 years, incomplete concordance between the preoperative localization of the lesion and thesurgical site, low serum vitamin B₆ level, and high level of serum monocyte chemoattractant protein-1 (MCP-1) were the significant risk factors for postoperative recurrence in refractory epilepsy patients (OR=2.705, 2.314, 1.790 and 2.284, P < 0.05). A regression model was built based on these findings, and an ROC curve for predicting postoperative recurrence in refractory epilepsy patients was plotted based on the predicted probability logit(P). When logit(P) exceeded 14.52, the area under the curve (AUC) was 0.850, with a sensitivity of 78.57% and a specificity of 80.67%.
Conclusion
In refractory epilepsy patients with surgical treatment, disease duration exceeding 5 years, incomplete concordance between the preoperative localization of the lesion and the surgical site, low serum vitamin B₆ level, and elevated MCP-1 level are identified as risk factors for postoperative recurrence. The established regression model for predicting postoperative recurrence in refractory epilepsy patients demonstrates a high predictive value, and can be utilized to identify populations with high-risk of recurrence and guide targeted interventions to reduce the risk of recurrence.
- refractory epilepsy,
- surgery,
- recurrence,
- risk factors,
- prediction model,
- intervention strategies

FullText(HTML)

References (21)

References

[1]	ZARNOWSKA I M. Therapeutic use of the ketogenic diet in refractory epilepsy: what we know and what still needs to be learned[J]. Nutrients, 2020, 12(9): 2616. doi: 10.3390/nu12092616
[2]	SCHAIQUEVICH P, RIVA N, MALDONADO C, et al. Clinical pharmacology of cannabidiol in refractory epilepsy[J]. Farm Hosp, 2020, 44(5): 222-229.
[3]	李欣, 王正阁, 张冰, 等. fMRI在颞叶癫痫术前定位和预后评估中的研究进展[J]. 磁共振成像, 2020, 11(8): 691-694. https://www.cnki.com.cn/Article/CJFDTOTAL-CGZC202008027.htm
[4]	SAN-JUAN D. Cathodal transcranial direct current stimulation in refractory epilepsy: a noninvasive neuromodulation therapy[J]. Clin Neurophysiol, 2021, 38(6): 503-508. doi: 10.1097/WNP.0000000000000717
[5]	中国抗癫痫协会. 临床诊疗指南·癫痫病分册[M]. 2版. 北京: 人民卫生出版社, 2015: 6-7.
[6]	KWAN P, ARZIMANOGLOU A, BERG A T, et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE Commission on Therapeutic Strategies[J]. Epilepsia, 2010, 51(6): 1069-1077. doi: 10.1111/j.1528-1167.2009.02397.x
[7]	BARBA C, BLUMCKE I, WINAWER M R, et al. Clinical features, neuropathology, and surgical outcome in patients with refractory epilepsy and brain somatic variants in the SLC35A2 gene[J]. Neurology, 2023, 100(5): e528-e542.
[8]	FEYS O, GOLDMAN S, LOLLI V, et al. Diagnostic and therapeutic approaches in refractory insular epilepsy[J]. Epilepsia, 2023, 64(6): 1409-1423. doi: 10.1111/epi.17571
[9]	LANGEH U, CHAWLA P, GUPTA G D, et al. A novel approach to refractory epilepsy by targeting pgperipherally and centrally: therapeutic targets and future perspectives[J]. CNS Neurol Disord Drug Targets, 2020, 19(10): 741-749.
[10]	NAIMO G D, GUARNACCIA M, SPROVIERI T, et al. A systems biology approach for personalized medicine in refractory epilepsy[J]. Int Mol Sci, 2019, 20(15): 3717. doi: 10.3390/ijms20153717
[11]	石先俊, 邓静, 孙晓琴, 等. 药物难治性癫痫首次手术失败的原因分析及再次手术的疗效[J]. 中国临床神经外科杂志, 2023, 28(5): 303-306, 310. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGLC202305004.htm
[12]	姜卉, 姜兵, 张伟, 等. 局灶性皮层发育不良相关难治性癫痫的手术预后影响因素分析[J]. 中国现代手术学杂志, 2023, 27(2): 139-144. https://www.cnki.com.cn/Article/CJFDTOTAL-XDSS202302012.htm
[13]	薛亚飞, 景芸芸, 张玉富. 不同FCD分型所致药物难治性癫痫患者的手术预后影响因素[J]. 海南医学, 2019, 30(16): 2085-2088. https://www.cnki.com.cn/Article/CJFDTOTAL-HAIN201916014.htm
[14]	李承俊, 王丰, 姚培森, 等. 局灶性皮质发育不良相关"难定位"难治性癫痫的手术疗效及影响因素分析[J]. 中华神经医学杂志, 2021, 20(8): 793-798. https://www.cnki.com.cn/Article/CJFDTOTAL-NENG201903004.htm
[15]	季涛云, 王若凡, 刘庆祝, 等. 局灶起源的药物难治性癫痫性痉挛的手术预后及相关预后因素分析[J]. 中华实用儿科临床杂志, 2021, 36(17): 1333-1337. https://cpfd.cnki.com.cn/Article/CPFDTOTAL-KDXX202010001154.htm
[16]	严得斌. 低级别胶质瘤相关癫痫患者术后癫痫预后分析[D]. 大连: 大连医科大学, 2019.
[17]	张毛松. 成人癫痫相关的幕上低级别胶质瘤术后癫痫复发的相关因素分析[D]. 合肥: 安徽医科大学, 2019.
[18]	黄军, 高安亮, 杨子茵, 等. 多脑叶癫痫的外科治疗疗效及危险因素分析[J]. 实用医院临床杂志, 2020, 17(1): 128-131. https://www.cnki.com.cn/Article/CJFDTOTAL-YYLC202001038.htm
[19]	舒丽. 难治性癫痫脑叶切除术后复发风险预测模型的建立与验证[D]. 乌鲁木齐: 新疆医科大学, 2023.
[20]	董晓杰, 曾宽, 田勤卿. 低级别胶质瘤合并癫痫患者手术预后相关影响因素分析[J]. 医学临床研究, 2019, 36(8): 1586-1588.
[21]	程慧冉. 多模态导航辅助电生理技术应用于脑胶质瘤治疗的效果及术后复发的影响因素分析[J]. 实用癌症杂志, 2022, 37(5): 836-839, 843. https://www.cnki.com.cn/Article/CJFDTOTAL-SYAZ202205037.htm

[1]	LI Jun, ZHANG Xizhi, QIAN Jiewei, ZHANG Xianwen, GUI Longgang, BAI Zhenglu, HOU Xiaoxiao, CHEN Xuemei. Dosimetric study of optimum treatment mode applied in intensity-modulated radiotherapy for postoperative rectal cancer[J]. Journal of Clinical Medicine in Practice, 2023, 27(9): 13-19, 38. DOI: 10.7619/jcmp.20230419
[2]	LI Ruibiao, REN Chengbo, WANG Cong, LI Yaru. Comparison of the efficacy of dosimetric parameters defined by different lung volume methods in predicting radiation pneumonitis in patients with non-small cell lung cancer[J]. Journal of Clinical Medicine in Practice, 2022, 26(19): 5-8, 13. DOI: 10.7619/jcmp.20221246
[3]	YUAN Meifang, YANG Yi, SUN Mengzhen, WEN Xiaobo, ZHAO Biao. Study on thyroid radiation dose of two intensity-modulated radiotherapy plans after radical mastectomy of left breast cancer[J]. Journal of Clinical Medicine in Practice, 2021, 25(24): 16-19. DOI: 10.7619/jcmp.20213277
[4]	ZHOU Hui, SHAN Shucan. Dosimetry and passing rate of forward-intensity modulated radiation therapy and intensity modulated radiation therapy for left breast cancer patients with breast conserving surgery[J]. Journal of Clinical Medicine in Practice, 2021, 25(1): 15-18. DOI: 10.7619/jcmp.20200319
[5]	PAN Xiang, YANG Yi, HOU Yu, YUAN Meifang. Dosimetric differences of different radiation modes based on Monaco in postoperative intensity modulated radiotherapy of patients with left breast-conserving surgery for breast cancer[J]. Journal of Clinical Medicine in Practice, 2021, 25(1): 1-5. DOI: 10.7619/jcmp.20200621
[6]	YUAN Meifang, ZHAO Biao, YANG Yi, TANG Kewei, AN Yijun. Static intensity-modulated radiotherapy versus volumetric modulated arc therapy in dosimetric parameters of target area and organs at risk for middle thoracic esophageal cancer[J]. Journal of Clinical Medicine in Practice, 2020, 24(15): 21-24. DOI: 10.7619/jcmp.202015006
[7]	PAN Xiang, LI Ya, ZHU Sijin, YANG Yi. Dosimetry difference between field-in-field intensity modulated radiation therapy and fixed field inversely optimized intensity modulated radiation therapy in whole brain radiotherapy[J]. Journal of Clinical Medicine in Practice, 2019, 23(19): 12-16. DOI: 10.7619/jcmp.201919003
[8]	AN Xuehong, CAO Hekui, DUAN Shuhao. Effect of spiral fault fixed field intensity modulated radiation therapy on esophageal cancer in middle segment[J]. Journal of Clinical Medicine in Practice, 2018, (11): 101-103. DOI: 10.7619/jcmp.201811028
[9]	LU Yuting, WANG Jian, LIN Tao, SUI Jianfeng, YU Jingping, NI Xinye, SUN Suping. Dosimetry comparison between two different supraclavicular areas irradiation schedules for post-operation breast cancer and its influence on life quality[J]. Journal of Clinical Medicine in Practice, 2016, (19): 34-36. DOI: 10.7619/jcmp.201619010
[10]	ZOU Qinzhou, WEI Xianding, ZHAO Yutian, ZHANG Fuzheng, YANG Bo. Irradiation of the chest wall and regional nodes as an integrated volume with IMRT for breast cancer after mastectomy:from dosimetry to clinical observation[J]. Journal of Clinical Medicine in Practice, 2012, (23): 32-35.

Cited By

Cited by

Periodical cited type(18)

1.	唐琪. 依帕司他联合甲钴胺治疗2型糖尿病周围神经病变的效果. 中外医学研究. 2024(09): 136-139 .
2.	陈丽媛，林富祥，韦春姣. 依帕司他片+硫辛酸注射液治疗糖尿病周围神经病变的临床效果. 糖尿病新世界. 2024(07): 183-186 .
3.	李志健. 依帕司他联合胰激肽原酶治疗糖尿病周围神经病变患者的效果. 中国民康医学. 2024(14): 28-30 .
4.	褚桂克，王凡. 益气养血通痹汤联合甲钴胺注射液治疗糖尿病周围神经病变的疗效及对神经传导速度的影响. 中医研究. 2023(04): 40-44 .
5.	赵媛媛，高烨，钱光芳. 甲钴胺与丹参多酚酸盐联合治疗糖尿病周围神经病变的效果研究. 糖尿病新世界. 2023(10): 187-190 .
6.	李彬彬，王民，田勇，楚清锋. 依帕司他联合α-硫辛酸治疗老年糖尿病周围神经病变的临床效果. 实用临床医学. 2022(02): 16-19 .
7.	尹永锋，李江涛，王润青. 依帕司他与α-硫辛酸分别联合甲钴胺治疗对糖尿病周围神经病变患者氧化应激及神经电生理的影响. 河南医学研究. 2022(06): 1103-1106 .
8.	王璇. 甲钴胺联合依帕司他治疗糖尿病周围神经病变的效果. 中国实用医药. 2022(15): 152-154 .
9.	李江敏子，刘殿池，尚菊菊，李景，林玥坤，韩强，张红升. 温经散寒法联合甲钴胺治疗糖尿病周围神经病变的疗效及对血清胱抑素C水平的影响. 中国临床研究. 2022(07): 932-937 .
10.	徐子奇，于鑫淼，任丽媛. 依帕司他联合甲钴胺治疗糖尿病周围神经病变的疗效. 中国现代药物应用. 2022(17): 154-156 .
11.	刘锦凤，许凯斯，何燕. 依帕司他片联合二甲双胍治疗糖尿病周围神经病变的疗效分析. 中国处方药. 2022(11): 89-91 .
12.	康宝清，蔡栋立，洪玮莉. 参芪降糖颗粒治疗糖尿病周围神经病变的临床效果及安全性分析. 糖尿病新世界. 2022(22): 66-69 .
13.	美娜·斯拉木江，李娜，张明珠，阿衣古丽·阿孜提哈孜. 苍柏逐瘀汤治疗糖尿病周围神经病变痰瘀阻络证临床观察. 山西中医. 2021(04): 19-21+24 .
14.	谭永华，谭永兰，陈士建. 甲钴胺、依帕司他联合神经血管治疗仪治疗糖尿病周围神经病变的临床效果. 中外医学研究. 2021(21): 51-53 .
15.	王秀阁，倪青，庞国明. 糖尿病周围神经病变病证结合诊疗指南. 中医杂志. 2021(18): 1648-1656 .
16.	刘天洋，叶奎. 痛性糖尿病周围神经病药物治疗进展. 中国城乡企业卫生. 2021(12): 45-47 .
17.	杜凌超，茹志成，孙蕾，陈鹤华. 依帕司他联合硫辛酸治疗糖尿病周围神经病变的临床效果. 慢性病学杂志. 2021(12): 1826-1828+1832 .
18.	陈晓娟. 血栓通联合依帕司他与甲钴胺在糖尿病周围神经病变中的应用及对神经传导功能的影响. 糖尿病新世界. 2021(21): 195-198 .

Other cited types(5)

Get Citation

PDF

XML

Article views (157) PDF downloads (29) Cited by(23)

Turn off MathJax

Article Contents

Abstract

References

Analysis in risk factors of postoperative recurrence of patients with refractory epilepsy and establishment of a risk prediction model