OBJECTIVE To develop a model to predict the probability of mood decline in adults following temporal lobe resection for the treatment of pharmacoresistant epilepsy. METHODS Variable selection was performed on 492 patients from the Cleveland Clinic using best subsets regression. After completing variable selection, a subset of variables was requested from four epilepsy surgery centers across North America (n = 100). All data were combined to develop a final model to predict postoperative mood decline (N = 592). Internal validation with bootstrap resampling was performed. A clinically significant increase in depressive symptoms was defined as a 15% increase in Beck Depression Inventory-Second Edition score and a postoperative raw score > 11. RESULTS Fourteen percent of patients in the Cleveland Clinic cohort and 22% of patients in the external cohort experienced clinically significant increases in depressive symptoms following surgery. The final prediction model included six predictor variables: psychiatric history, resection side, relationship status, verbal fluency score, age at preoperative testing, and presence/absence of malformation of cortical development on magnetic resonance imaging. The model had an optimism-adjusted c-statistic of .70 and good calibration, with slight probability overestimation in higher risk patients. SIGNIFICANCE Clinicians can utilize our nomogram via a paper tool or online calculator to estimate the risk of postoperative mood decline for individual patients prior to temporal lobe epilepsy surgery.

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预测成人颞叶癫痫手术后的情绪下降

目的 建立一个模型来预测成人颞叶切除治疗耐药性癫痫后情绪下降的可能性。方法 使用最佳子集回归对来自克利夫兰诊所的 492 名患者进行变量选择。完成变量选择后，从北美的四个癫痫手术中心（n = 100）请求了一个变量子集。合并所有数据以开发最终模型以预测术后情绪下降（N = 592）。使用自举重采样进行内部验证。抑郁症状的临床显着增加定义为贝克抑郁量表第二版评分增加 15% 且术后原始评分 > 11。结果 克利夫兰诊所队列中 14% 的患者和外部队列中 22% 的患者在手术后经历了临床上显着的抑郁症状增加。最终的预测模型包括六个预测变量：精神病史、切除侧、关系状态、语言流畅度评分、术前测试的年龄以及磁共振成像中皮质发育畸形的存在/不存在。该模型具有 0.70 的乐观调整 c 统计量和良好的校准，高风险患者的概率略有高估。意义 临床医生可以通过纸质工具或在线计算器利用我们的列线图来估计个体患者在颞叶癫痫手术前出现术后情绪下降的风险。