Analysis Of Clinical Characteristics And Risk Factors And Development Of Predictive Model Of Cerebral Cavernous Malformation Related Epilepsy

Objective: The present study is to explore the clinical characteristics and risk factors of cerebral cavernous malformation related epilepsy(CRE),and to development a reliable Nomogram to predict the risk of CRE.Methods: We retrospectively collected the clinical data of cerebral cavernous malformation(CCM)patients from June 2007 to June 2017 in the affiliated hospitals of Chongqing Medical University.Summarize the clinical characteristics of CRE,and then univariate analysis and binary logistic regression analysis were used to analyze the risk factors of CRE.The Nomogram of CRE was developed by R studio via using the results of binary logistic regression analysis.To quantify the discrimination performance of the CRE Nomogram,the receiver-operation characteristic curve(ROC)was plotted and the area under the receiver-operation characteristic curve(AUC)was measured.The calibration curve and Hosmer-Lemeshow test were used to assess the calibration of the CRE Nomogram.Then,We divided the patients into high-risk group and low-risk group according tothe Youden index of ROC.Bootstrap was used to validate this Nomogram.Results:1.A total of 199 CCM patients were enrolled in this study,93 of whom were diagnosed with CRE.The mean age of CRE was 36.0 ± 15.2years,and the male to female ratios was 1.38.CCM were most commonly found in the temporal lobe(51.6%,n=48),followed by the frontal lobe(33.3%,n=31),the parietal lobe(8.6%,n=8),occipital lobe(4.3%,n=4),basal ganglia(1.1%,n=1)and the corpus callosum(1.1%,n=1).Of the 93 patients,18.3% of whom had status epilepticus.According to the 1981 classification of seizure by the International League Against Epilepsy(ILAE),the most common seizure type was secondary general tonic-clonic seizure(59.0%),followed by complex partial seizure(27.9%)and simple partial(13.1%).According to the 2017 classification of seizure by the ILAE,the most common seizure type was focal to bilateral tonic-clonic(53.3%),followed by focal impaired awareness with motor(26.4%),focal impaired awareness without motor(9.0%),focal aware without motor(8.2%),focal aware with motor(4.9%).2.Binary logistic regression analysis showed that age ? 44 years old(OR=2.67,95% CI: 1.27-5.62,P=0.010),temporal lobe location(OR=4.58,95% CI: 2.09-10.05,P<0.001),cortical involvement(OR=21.28,95% CI:2.54-178.19,P=0.005)and hemosiderin rim(OR=5.31,95% CI: 2.18-12.94,P<0.001)were the risk factors of CRE.The AUC of the CRE Nomogramwas 0.83(95% CI: 0.77-0.88),and was confirmed to be 0.83 through bootstrap validation.Calibration curve and Hosmer-Lemeshow test indicated that the predicted results of the Nomogram were in good agreement with the observed results.According to the Youden index of ROC,the CRE predictive risk higher than 30.6% were divided into high-risk group,and the CRE predictive risk lower than 30.6% were divided into low-risk group.Conclusions:1.The commonest age group of CRE is 41-50 years.CCM were most commonly found in the temporal lobe.The seizure type of CRE are varied,the most common seizure type was secondary general tonic-clonic seizure(focal to bilateral tonic-clonic).2.Age ? 44 years old,temporal lobe location,cortical involvement and hemosiderin rim were the risk factors of CRE.3.We development a Nomogram of CRE based on the clinical data of age,lesion location,cortex involvement and hemosiderin rim,which will be helpful to individually predict the risk of CRE.