Development of a Seizure Matching System for Clinical Decision Making in Epilepsy Surgery
Bibliographic record
Abstract
Abstract Background and Objectives The proportion of patients becoming seizure-free after epilepsy surgery has stagnated. Large multi-center stereo-electroencephalography datasets can potentially allow comparing a new patient to past similar cases and make clinical decisions with the knowledge of how similar cases were treated in the past. However, the complexity of these evaluations makes the manual search for similar patients in a large database impractical. We aim to develop an automated system that electrographically and anatomically matches seizures from a patient to those in a database. In addition, since we do not know what features define seizure similarity, particularly considering the various stereo-electroencephalography implantation schemes, we evaluate the agreement and features among experts in classifying seizure similarity. Methods We utilized SEEG seizures from consecutive patients who underwent stereo-electroencephalography for epilepsy surgery. Eight international experts evaluated seizure-pair similarity using a four-level similarity score through a graphical user interface. As our primary outcome, we developed and validated an automated seizure matching system by employing a leave-one-expert-out approach. Secondary outcomes included the inter-rater agreement and features for classifying seizure similarity. Results 320 SEEG seizures from 95 patients were utilized. The seizure matching system achieved an area-under-the-curve of 0.82 (95% CI, 0.819-0.822), indicating its feasibility. Six distinct seizure similarity features were identified and proved effective: onset region, onset pattern, propagation region, duration, extent of spread, and propagation speed. Among these features, the onset region showed the strongest correlation with expert scores (Spearman’s rho=0.75, p <0.001). Additionally, the moderate inter-rater agreement confirmed the practicality of our approach: for the four-level classification, median agreement was 73.9% (interquartile range, 7%), and beyond-chance Gwet’s kappa was 0.45 (0.16); for the binary classification of similar vs. not related, agreement stood at 71.9% (4.7%) with a kappa of 0.46 (0.13). Discussion We demonstrate the feasibility and validity of a stereo-electroencephalography seizure matching system across patients, effectively mirroring the expertise of epileptologists. This novel system can identify patients with seizures similar to that of a patient being evaluated, thus optimizing the treatment plan by considering the treatment and the results of treating similar patients in the past, potentially resulting in an improved surgery outcome.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.023 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".