Machine learning models for decision support in epilepsy management: A critical review

Purpose: There remain major challenges for the clinician in managing patients with epilepsy effectively. Choosing anti-seizure medications (ASMs) is subject to trial and error. About one-third of patients have drug-resistant epilepsy (DRE). Surgery may be considered for selected patients, but time from diagnosis to surgery averages 20 years. We reviewed the potential use of machine learning (ML) predictive models as clinical decision support tools to help address some of these issues. Methods: We conducted a comprehensive search of Medline and Embase of studies that investigated the application of ML in epilepsy management in terms of predicting ASM responsiveness, predicting DRE, identifying surgical candidates, and predicting epilepsy surgery outcomes. Original articles addressing these 4 areas published in English between 2000 and 2020 were included. Results: We identified 24 relevant articles: 6 on ASM responsiveness, 3 on DRE prediction, 2 on identifying surgical candidates, and 13 on predicting surgical outcomes. A variety of potential predictors were used including clinical, neuropsychological, imaging, electroencephalography, and health system claims data. A number of different ML algorithms and approaches were used for prediction, but only one study utilized deep learning methods. Some models show promising performance with areas under the curve above 0.9. However, most were single setting studies (18 of 24) with small sample sizes (median number of patients 55), with the exception of 3 studies that utilized large databases and 3 studies that performed external validation. There was a lack of standardization in reporting model performance. None of the models reviewed have been prospectively evaluated for their clinical benefits. Conclusion: The utility of ML models for clinical decision support in epilepsy management remains to be determined. Future research should be directed toward conducting larger studies with external validation, standardization of reporting, and prospective evaluation of the ML model on patient outcomes. (c) 2021 Elsevier Inc. All rights reserved.