An evidence-based checklist to assess neuropsychological outcomes of epilepsy surgery: How good is the evidence?

Abstract Purpose We aimed to assess the quality of evidence on neuropsychological outcomes after epilepsy surgery (ES). Accordingly, we created an evidence-based neuropsychology (EBNP) checklist to assess neuropsychological outcomes and applied this tool to studies from a systematic review. Methods The EBNP checklist was created using clinical expert input, scale development methodology for item generation and reduction and inter-rater reliability, and critical appraisal guidelines for studies about treatment. The checklist was applied to articles obtained through a systematic review of resective ES neuropsychological outcomes. The proportion of studies fulfilling the quality criteria and the total quality score were used to assess the quality of the evidence. Results An initial 45-item checklist was applied to 147 articles, with excellent inter-rater agreement (kappa = 0.80). The mean quality score was 23 (SD: 4, range: 12–33). There was substantial variability in the percentage of studies meeting the criteria for specific items (0–99%). The median proportion of papers fulfilling various quality criteria was 1.4% for items related to group comparisons, 37% for clinical applicability, 67% for patient description, 78% for outcome assessment, and 91% for interventions. Higher quality correlated with longitudinal design, reporting presurgical IQ, seizure frequency and antiepileptic drugs, and using validated measures of change in individual patients. The final EBNP checklist consisted of 19 items. Discussion The EBNP checklist reliably identified quality strengths and threats to validity of neuropsychological outcome studies in ES. Studies would be most improved by the inclusion of random allocation to interventions or at minimum blinded outcome assessment, empirically based measures of reliable change and completeness of reporting of follow-up.