Predicting seizure freedom with AED treatment in newly diagnosed patients with MRI-negative epilepsy: A large cohort and multicenter study

Shijun Yang; Xiong Han; Na Wang; Renjun Gu; Wenwu Chen; Enfeng Wang; Yi Chen; Guinv He; Xuerui Zhu; Bingqian Ma; Mingmin Li; Pan Zhao; Jiuyan Han; Yuan Fang; Jiao Zeng; Yan Bai; Ting Zhao; Yanan Chen

doi:10.1016/j.yebeh.2020.107022

Predicting seizure freedom with AED treatment in newly diagnosed patients with MRI-negative epilepsy: A large cohort and multicenter study

Epilepsy Behav. 2020 May:106:107022. doi: 10.1016/j.yebeh.2020.107022. Epub 2020 Mar 24.

Authors

Shijun Yang¹, Xiong Han², Na Wang³, Renjun Gu⁴, Wenwu Chen⁵, Enfeng Wang⁶, Yi Chen⁷, Guinv He³, Xuerui Zhu¹, Bingqian Ma¹, Mingmin Li³, Pan Zhao³, Jiuyan Han⁸, Yuan Fang⁵, Jiao Zeng⁹, Yan Bai⁶, Ting Zhao³, Yanan Chen³

Affiliations

¹ Department of Neurology, People's Hospital of Zhengzhou University, Zhengzhou, Henan Province 450003, China.
² Department of Neurology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, Henan Province 450003, China. Electronic address: hanxiong7589@126.com.
³ Department of Neurology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, Henan Province 450003, China.
⁴ Department of Neurology, the Second Affiliated Hospital of Xinxiang Medical University, Henan Mental Hospital, Xinxiang, Henan Province 543002, China. Electronic address: gurenjun1961@163.com.
⁵ Department of Neurology, the First Affiliated Hospital of Henan University, Kaifeng, Henan Province 475000, China.
⁶ Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, Henan Province 450003, China.
⁷ Clinical Research Service Center, Henan Provincial People's Hospital, Zhengzhou, Henan Province 450003, China.
⁸ Department of Clinical Medicine, Zhengzhou University, Zhengzhou, Henan Province 450003, China.
⁹ Department of Neurology, the Second Affiliated Hospital of Xinxiang Medical University, Henan Mental Hospital, Xinxiang, Henan Province 543002, China.

PMID: 32217419
DOI: 10.1016/j.yebeh.2020.107022

Abstract

Objective: We developed and validated a prediction score for predicting the probability of 6-month and 12-month seizure freedom of antiepileptic drug (AED) treatment in newly diagnosed patients with magnetic resonance imaging (MRI)-negative epilepsy.

Methods: The development cohort included 543 consecutive patients from the Epilepsy Center of Henan Provincial People's Hospital, while the validation cohorts included 493 consecutive patients in two independent cohorts. Univariate analysis and a forward and backward elimination of multivariate Cox regression analysis were used to select predictive factors. The performance of the score was evaluated with C-index, calibration plots, and decision curve analysis. The risk stratification was also performed.

Results: The score included five routinely available predictors including Circadian rhythms, Electroencephalography before AED treatment, Neuropsychiatric disorders, Perinatal brain injury, and History of central nervous system infection (CENPH score). When applied to the external validation cohort, the score showed good discrimination with C-index (development group: 0.83; validation group: 0.78), and calibration plots indicated well calibration, as well as the decision curve analysis showed good predictive accuracy and clinical values in four cohorts. The points of the score were categorized to the following three probability levels for predicting seizure freedom: high probability (0-83.11 points), medium probability (83.11-122.71 points), and low probability (>122.71 points). And online calculator was established to make this score easily applicable in clinical practice.

Conclusions: We established a simple, practical, and evidence-based prediction score for predicting seizure freedom with AEDs to aid in the clinical consultation and treatment decision for the newly diagnosed patients with MRI-negative epilepsy.

Keywords: Antiepileptic drugs; Clinical decision; MRI-negative epilepsy; Prediction model; Seizure freedom.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Anticonvulsants / therapeutic use*
Cohort Studies
Electroencephalography / methods
Epilepsy / diagnostic imaging*
Epilepsy / drug therapy*
Epilepsy / physiopathology
Female
Humans
Magnetic Resonance Imaging / methods*
Male
Middle Aged
Predictive Value of Tests
Pregnancy
Retrospective Studies
Seizures / diagnostic imaging*
Seizures / drug therapy*
Seizures / physiopathology
Treatment Outcome
Young Adult

Substances

Anticonvulsants