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Risk of seizure recurrence in people with single seizures and early epilepsy - Model development and external validation

Bonnett, LJ; Kim, L; Johnson, A; Sander, JW; Lawn, N; Beghi, E; Leone, M; (2022) Risk of seizure recurrence in people with single seizures and early epilepsy - Model development and external validation. Seizure , 94 pp. 26-32. 10.1016/j.seizure.2021.11.007. Green open access

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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.

Type: Article
Title: Risk of seizure recurrence in people with single seizures and early epilepsy - Model development and external validation
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.seizure.2021.11.007
Publisher version: https://doi.org/10.1016/j.seizure.2021.11.007
Language: English
Additional information: © 2021 The Authors. Published by Elsevier Ltd on behalf of British Epilepsy Association. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Keywords: Independent data, Newly diagnosed, Prognosis, Risk assessment
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Clinical and Experimental Epilepsy
URI: https://discovery.ucl.ac.uk/id/eprint/10140056
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