Epilepsy Surgery Nomogram Draws $3.4M NIH Grant

The National Institutes of Health (NIH) has awarded a $3.4 million grant to Cleveland Clinic to develop a tool to predict individual outcomes in epilepsy surgery. The five-year grant, led by Lara Jehi, MD (pictured above), supports development of a comprehensive epilepsy surgery nomogram using diagnostic technology and predictive modeling.

The project is a collaboration among the Epilepsy Center in Cleveland Clinic’s Neurological Institute, the Cleveland Clinic Lerner Research Institute’s Quantitative Health Sciences team, Mayo Clinic and the University of Campinas in Brazil. The initiative will incorporate robust patient data into the nomogram, or risk calculator, to better determine which patients will most benefit from epilepsy surgery.

Meeting a real-world clinical need

“The typical current path to epilepsy surgery reveals an unquestionable need for process improvements that could be fostered by a tool like the epilepsy surgery nomogram,” says Dr. Jehi, Research Director of the Epilepsy Center.

“Patients now hear what the ‘average’ chance of success is with a brain surgery procedure, but they do not know what their individual chance of success is,” she explains. “The nomogram will enable us to bring patient counseling into the 21st century and expand it beyond our best ‘educated opinion’ to actual science. It will arm physicians with an advanced statistical tool to better select optimal surgical candidates and estimate the likelihood of seizure freedom after epilepsy surgery.”

She adds that use of the tool may help reverse underutilization of epilepsy surgery for drug-resistant epilepsy — underutilization that’s partially attributable to limitations in the ability to predict surgical outcomes in an individualized way.

Building on prior work

The multicenter research team will build upon on its first epilepsy surgery nomogram, which used basic patient characteristics, including age, gender and seizure frequency, to provide an objective, individualized prediction of postoperative seizure outcomes at two and five years after epilepsy surgery. That nomogram and its initial retrospective validation were published in Lancet Neurology in 2015, as detailed in this Consult QD post.

Through this new grant, the researchers will create an enhanced risk calculator by adding additional clinical, imaging, genetic, electrophysiological and histopathology data. The comprehensive nomogram will be developed from a retrospective cohort of 450 patients from Cleveland Clinic, Mayo Clinic and the University of Campinas, and then be prospectively validated in 250 patients from the same centers.

“When completed, this project will generate the first objective, validated, user-friendly epilepsy surgery prediction tool,” says Dr. Jehi. “Instead of each physician working on an island, we can synthesize data and pull it all together to make more strategic predictions using a much more scientific decision-making process. Achieving this goal will improve patient counseling and benefit public health.”

New application for an established concept

The nomogram concept was pioneered at Cleveland Clinic by Michael Kattan, PhD, Chair of Quantitative Health Sciences, to help better predict outcomes for patients. His risk calculators, designed to help physicians make informed decisions about patient care, have been applied to many diseases, including coronary artery disease, an array of cancers, type 2 diabetes and total joint replacements.

“The development of risk prediction calculators like the epilepsy surgery nomogram is vital for improving medical decision-making,” notes Dr. Kattan. “Tools like this represent another step toward personalized medicine that will ultimately improve efficiency, outcomes and patient care.”