Risk of seizure recurrence in people with single seizures and early epilepsy - Model development and external validation.
View / Open Files
Authors
Bonnett, Laura J
Johnson, Anthony
Sander, Josemir W
Lawn, Nicholas
Beghi, Ettore
Leone, Maurizio
Marson, Anthony G
Publication Date
2021-11-28Journal Title
Seizure
ISSN
1059-1311
Publisher
Elsevier BV
Volume
94
Pages
26-32
Type
Article
This Version
VoR
Physical Medium
Print-Electronic
Metadata
Show full item recordCitation
Bonnett, L. J., Kim, L., Johnson, A., Sander, J. W., Lawn, N., Beghi, E., Leone, M., & et al. (2021). Risk of seizure recurrence in people with single seizures and early epilepsy - Model development and external validation.. Seizure, 94 26-32. https://doi.org/10.1016/j.seizure.2021.11.007
Abstract
PURPOSE: Following a single seizure, or recent epilepsy diagnosis, it is difficult to balance risk of medication side effects with the potential to prevent seizure recurrence. A prediction model was developed and validated enabling risk stratification which in turn informs treatment decisions and individualises counselling. METHODS: Data from a randomised controlled trial was used to develop a prediction model for risk of seizure recurrence following a first seizure or diagnosis of epilepsy. Time-to-event data was modelled via Cox's proportional hazards regression. Model validity was assessed via discrimination and calibration using the original dataset and also using three external datasets - National General Practice Survey of Epilepsy (NGPSE), Western Australian first seizure database (WA) and FIRST (Italian dataset of people with first tonic-clonic seizures). RESULTS: People with neurological deficit, focal seizures, abnormal EEG, not indicated for CT/MRI scan, or not immediately treated have a significantly higher risk of seizure recurrence. Discrimination was fair and consistent across the datasets (c-statistics: 0.555 (NGPSE); 0.558 (WA); 0.597 (FIRST)). Calibration plots showed good agreement between observed and predicted probabilities in NGPSE at one and three years. Plots for WA and FIRST showed poorer agreement with the model underpredicting risk in WA, and over-predicting in FIRST. This was resolved following model recalibration. CONCLUSION: The model performs well in independent data especially when recalibrated. It should now be used in clinical practice as it can improve the lives of people with single seizures and early epilepsy by enabling targeted treatment choices and more informed patient counselling.
Keywords
Independent data, Newly diagnosed, Prognosis, Risk assessment, Anticonvulsants, Australia, Epilepsy, Humans, Probability, Seizures
Sponsorship
British Heart Foundation (None)
British Heart Foundation (RG/18/13/33946)
National Institute for Health Research (IS-BRC-1215-20014)
Identifiers
External DOI: https://doi.org/10.1016/j.seizure.2021.11.007
This record's URL: https://www.repository.cam.ac.uk/handle/1810/336702
Statistics
Total file downloads (since January 2020). For more information on metrics see the
IRUS guide.
Recommended or similar items
The current recommendation prototype on the Apollo Repository will be turned off on 03 February 2023. Although the pilot has been fruitful for both parties, the service provider IKVA is focusing on horizon scanning products and so the recommender service can no longer be supported. We recognise the importance of recommender services in supporting research discovery and are evaluating offerings from other service providers. If you would like to offer feedback on this decision please contact us on: support@repository.cam.ac.uk