Epilepsy surgery: How accurate are multidisciplinary teams in predicting outcome?
Introduction from Dr Markus Reuber, editor-in-chief of Seizure
Health professionals who choose to specialise in the treatment of patients with seizure disorders have to have a particular affinity to dealing with probabilities and have to comfortable with the management of uncertainty. Individuals without these characteristics are much more likely to be working in specialities in which definite diagnoses can be made most of time – by measuring something, doing a scan, or looking through a microscope. In areas where there is reasonably secure clinical knowledge in epileptology, this knowledge often relates to groups rather than individual patients. For instance several studies have now shown that about 60% of patients newly presenting with epilepsy become seizure free, or that 30-40% of adults with a history of epilepsy are likely to remain seizure free if antiepileptic drugs are withdrawn after three or more years of complete seizure control. What we don’t know is what is likely to happen to the patient in front of us. Will they be amongst the majority with a good outcome – or will they do badly.
The paper by Sally Baxendale et al. which is the Editor’s Choice in this issue of Seizure examines how well the members of an experienced epilepsy surgery team do when they try to predict the chance of postoperative seizure-freedom to patients before temporal lobe epilepsy surgery. As it turns out – the epilepsy surgery team was actually very good at individualising their patients likely postoperative seizure outcome – at least for patients with close-to-average seizure outcomes. They did less well with their predictions of particularly bad or especially good outcomes. Overall, experienced clinicians did better than a statistical model.
There is clearly a lot more to learn about optimising clinical decision making in epileptology in general and about translating the results of clinical studies to individual patients. It would also be of interest to study what patients understand when doctors tell them that they have a 55% chance of seizure-freedom. The paper by Sally Baxendale et al. is an interesting and inspiring first step.