Busch et al evaluated adults with epilepsy undergoing temporal lobe surgery. They developed a nomogram for predicting the risk of meaningful decline in naming. The authors are from the Cleveland Clinic, Columbia University, Emory University, University of Wisconsin and University of Washington Seattle.
Patient selection: temporal lobe surgery for epilepsy, age of onset from 0 to 60 years, years of education 8 to 21, age at surgery 15 to 75 years
Outcome: meaningful decline in naming, defined as decline by >= 5 points in the 60-item Boston Naming Test (scored from 0 to 60)
Parameters:
(1) age at seizure onset
(2) site of resection (dominant vs nondominant temporal lobe)
(3) age at surgery
(4) patient sex
(5) years of education
points for age at seizure onset =
= 1.5383 * (age at onset)
points for age at surgery =
= (0.4667 * (age at surgery)) - 7
points for years of education =
= (1.54615 * (years)) - 2.7
|
Parameter
|
Finding
|
Points
|
|
site of resection
|
nondominant
|
0
|
|
|
dominant
|
85.1
|
|
sex
|
male
|
0
|
|
|
female
|
12.2
|
total score =
= (points for age at seizure onset) + (points for site of resection) + (points for age at surgery) + (points for sex) - (points for years of education)
Interpretation:
• minimum score: -29.7
• maximum score: 208
• The risk of decline increases as the score increases.
|
Score
|
Percent with Meaningful Decline in Naming
|
|
< 48.6
|
< 10%
|
|
48.6 to 117.5
|
(0.0043789 * ((score)^2)) - (0.14987 * (score)) + 7.0325
|
|
117.5 to 188.1
|
(-0.0037837 * ((score)^2)) + (1.722 * (score)) - 100.09
|
|
> 188.1
|
> 90%
|
Performance:
• The area under the ROC curve is 0.81.
