Identification of patients who will not achieve seizure remission within 5 years on AEDs



Hughes, David ORCID: 0000-0002-1287-9994, Bonnett, LJ ORCID: 0000-0002-6981-9212, Czanner, G, Arnost, Komarek, Marson, anthony ORCID: 0000-0002-6861-8806 and Garcia-Finana, M
(2018) Identification of patients who will not achieve seizure remission within 5 years on AEDs. Neurology, 91 (22). e2035 - e2044.

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Abstract

Objective To identify people with epilepsy who will not achieve a 12-month seizure remission within 5 years of starting treatment. Methods The Standard and New Antiepileptic Drug (SANAD) study is the largest prospective study in patients with epilepsy to date. We applied a recently developed multivariable approach to the SANAD dataset that takes into account not only baseline covariates describing a patient's history before diagnosis but also follow-up data as predictor variables. Results Changes in number of seizures and treatment history were the most informative time-dependent predictors and were associated with history of neurologic insult, epilepsy type, age at start of treatment, sex, and having a first-degree relative with epilepsy. Our model classified 95% of patients. Of those classified, 95% of patients observed not to achieve remission at 5 years were correctly classified (95% confidence interval [CI] 89.5%–100%), with 51% identified by 3 years and 90% within 4 years of follow-up. Ninety-seven percent (95% CI 93.3%–98.8%) of patients observed to achieve a remission within 5 years were correctly classified. Of those predicted not to achieve remission, 76% (95% CI 58.5%–88.2%) truly did not achieve remission (positive predictive value). The predictive model achieved similar accuracy levels via external validation in 2 independent United Kingdom–based datasets. Conclusion Our approach generates up-to-date predictions of the patient's risk of not achieving seizure remission whenever new clinical information becomes available that could influence patient counseling and management decisions.

Item Type: Article
Depositing User: Symplectic Admin
Date Deposited: 15 Nov 2018 10:50
Last Modified: 27 Nov 2020 10:16
DOI: 10.1212/WNL.0000000000006564
Open Access URL: http://doi.org/10.1212/wnl.0000000000006564
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URI: http://livrepository.liverpool.ac.uk/id/eprint/3028887

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