Authors :
Presenting Author: Lindsey Trank, BS – Ohio University Heritage College of Osteopathic Medicine, Columbus, OH
Amanda Weber, DO – Division of Neurology, Department of Pediatrics, Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, OH
Christopher Beatty, MD, MAS – Division of Neurology, Department of Pediatrics, Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, OH
Gabrielle Brown-Mitchell, MS – Division of Neurology, Department of Pediatrics, Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, OH
Mariah Eisner, MS – Biostatistics Resource at Nationwide Children’s Hospital, Columbus, OH
Jonathan Pindrik, MD – Division of Pediatric Neurosurgery, Department of Neurological Surgery, Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, OH
Ammar Shaikhouni, MD, PhD – Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, OH
Adam Ostendorf, MD – Division of Neurology, Department of Pediatrics, Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, OH
Rationale: The 5-SENSE score incorporates five variables (focal lesion on MRI, absence of bilateral independent spikes on scalp electroencephalography (EEG), localizing neuropsychological deficit, localizing seizure semiology, and regional ictal scalp EEG onset) to predict which patients are unlikely to have a focal seizure onset zone (SOZ) on stereoelectroencephalography (SEEG). This score has been validated primarily in adults, but its performance in a pediatric cohort is unknown [1].
Methods: A 5-SENSE score was retrospectively calculated for each patient in a single-center pediatric cross-sectional cohort (N=100, median age at SEEG of 14 yrs). The sensitivity and specificity for predicting a non-focal SEEG was plotted on a receiver operating characteristic (ROC) curve. We tested the association between lateralizing ancillary testing (e.g. positron emission tomography (PET), magnetoencephalography, and/or single-photon emission computed tomography) and SEEG focality. The association between 5-SENSE and outcomes was examined with the Jonckheere-Terpstra test.
Results: The 5-SENSE score predicted a non-focal SOZ for 44/98 (45%), with a specificity of 74.5% (95% CI, 63.6-85.5), sensitivity of 48.9 (95% CI, 35.6-62.2), and area under the curve of 0.673 (95% CI, 0.567-0.78). Ancillary testing was concordant (63/98) more often when 5-SENSE predictions were correct (p=0.001), but it did not improve prediction of the SEEG result when 5-SENSE predictions were incorrect (p=0.7). The median 5-SENSE scores decreased with worsening Engel class (p=0.037).
Conclusions:
In a single-center pediatric cohort, the 5-SENSE score performed comparably to the published adult validation cohort [1]. A low 5-SENSE score was associated with a non-focal SEEG. Ancillary testing not included in the original 5-SENSE score (e.g. PET) was confirmatory with the 5-SENSE score but does not predict SEEG result when the 5-SENSE score was incorrect. 5-SENSE scores were associated with seizure-related post-operative outcomes. Use of the 5-SENSE score in pediatric patients may improve patient selection for SEEG but is not a perfect predictor of result or outcome.
1. Astner-Rohracher, A. et al. Development and Validation of the 5-SENSE Score to Predict Focality of the Seizure-Onset Zone as Assessed by Stereoelectroencephalography. JAMA Neurol 79, 1–10 (2022).
Funding: None