title: Predictive model for refractoriness in temporal lobe epilepsy based on clinical and diagnostic test data.
abstract: BACKGROUND
  Temporal Lobe Epilepsy (TLE) is frequently resistant to drug treatment, but a high percentage of these patients can be free of seizures after epilepsy surgery. Delay in the surgical decision has been related to quality of life impairment, social and work limitations, and increased mortality risk. A predictive model for refractoriness based on clinical and diagnostic factors may allow its earlier detection and a shorter delay before surgery.
  
  
  METHODS
  A case-control study was conducted in TLE patients over 16 years old. The dependent variable was resistance to medical treatment according to ILAE 2010 criteria. Independent variables were clinical, semiological, therapeutic, neurophysiological, radiological, and neuropsychological variables. A multivariate study was conducted to identify the variables associated with refractoriness, calculating the positive and negative predictive values and positive likelihood ratios of these variables individually and in combination. These data were used to construct a refractoriness predictive model.
  
  
  RESULTS
  ILAE refractoriness criteria were met by 83 patients (50.9%). In the multivariate analysis, refractoriness was significantly associated with one semiological variable, one neuroradiological variable, one neurophysiological variable, and two therapeutic variables but not with neuropsychological test outcomes. These significant variables were used to construct a predictive model.
  
  
  CONCLUSIONS
  Assessment of semiological, neurophysiological, and neuroradiological data can serve to stratify the risk of refractory epilepsy in TLE patients.
authors.affiliation: Neurology and Neurophysiology Unit, Hospital Torrecárdenas, Paraje de Torrecárdenas s/n, Almeria, Spain. pedroj.serrano.sspa@juntadeandalucia.es
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: Serrano-Castro
authors.forename: Manuel
authors.initials: M
authors.lastname: Payan-Ortiz
authors.forename: Pablo
authors.initials: P
authors.lastname: Quiroga-Subirana
authors.forename: Javier
authors.initials: J
authors.lastname: Fernandez-Perez
authors.forename: Tesifon
authors.initials: T
authors.lastname: Parron-Carreño
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003627:Data Interpretation, Statistical; D018450:Disease Progression; D004351:Drug Resistance; D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications / Q000523:psychology; D004833:Epilepsy, Temporal Lobe / Q000175:diagnosis* / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D018570:Risk Assessment; D055815:Young Adult
chemical_list: D000927:Anticonvulsants