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Kaushik M, Mahajan S, Machahary N, Thakran S, Chopra S, Tomar RV, Kushwaha SS, Agarwal R, Sharma S, Kukreti R, Biswal B. Predicting efficacy of antiseizure medication treatment with machine learning algorithms in North Indian population. Epilepsy Res 2024; 205:107404. [PMID: 38996687 DOI: 10.1016/j.eplepsyres.2024.107404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/04/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024]
Abstract
PURPOSE This study aimed to develop a classifier using supervised machine learning to effectively assess the impact of clinical, demographical, and biochemical factors in accurately predicting the antiseizure medications (ASMs) treatment response in people with epilepsy (PWE). METHODS Data was collected from 786 PWE at the Outpatient Department of Neurology, Institute of Human Behavior and Allied Sciences (IHBAS), New Delhi, India from 2005 to 2015. Patients were followed up at the 2nd, 4th, 8th, and 12th month over the span of 1 year for the drugs being administered and their dosage, the serum drug levels, the frequency of seizure control, drug efficacy, the adverse drug reactions (ADRs), and their compliance to ASMs. Several features, including demographic details, medical history, and auxiliary examinations electroencephalogram (EEG) or Computed Tomography (CT) were chosen to discern between patients with distinct remission outcomes. Remission outcomes were categorized into 'good responder (GR)' and 'poor responder (PR)' based on the number of seizures experienced by the patients over the study duration. Our dataset was utilized to train seven classical machine learning algorithms i.e Extreme Gradient Boost (XGB), K-Nearest Neighbor (KNN), Support Vector Classifier (SVC), Decision Tree (DT), Random Forest (RF), Naïve Bayes (NB) and Logistic Regression (LR) to construct classification models. RESULTS Our research findings indicate that 1) among the seven algorithms examined, XGB and SVC demonstrated superior predictive performances of ASM treatment outcomes with an accuracy of 0.66 each and ROC-AUC scores of 0.67 (XGB) and 0.66 (SVC) in distinguishing between PR and GR patients. 2) The most influential factor in discerning PR to GR patients is a family history of seizures (no), education (literate) and multitherapy with Chi-square (χ2) values of 12.1539, 8.7232 and 13.620 respectively and odds ratio (OR) of 2.2671, 0.4467, and 1.9453 each. 3). Furthermore, our surrogate analysis revealed that the null hypothesis for both XGB and SVC was rejected at a 100 % confidence level, underscoring the significance of their predictive performance. These findings underscore the robustness and reliability of XGB and SVC in our predictive modelling framework. SIGNIFICANCE Utilizing XG Boost and SVC-based machine learning classifier, we successfully forecasted the likelihood of a patient's response to ASM treatment, categorizing them as either PR or GR, post-completion of standard epilepsy examinations. The classifier's predictions were found to be statistically significant, suggesting their potential utility in improving treatment strategies, particularly in the personalized selection of ASM regimens for individual epilepsy patients.
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Affiliation(s)
- Mahima Kaushik
- Cluster Innovation Centre, University of Delhi, Delhi, India
| | | | - Nitin Machahary
- Genomics and Molecular Medicine Unit, Institute of Genomics and Integrative Biology (IGIB), Council of Scientific and Industrial Research (CSIR), Delhi 110007, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Sarita Thakran
- Genomics and Molecular Medicine Unit, Institute of Genomics and Integrative Biology (IGIB), Council of Scientific and Industrial Research (CSIR), Delhi 110007, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Saransh Chopra
- Cluster Innovation Centre, University of Delhi, Delhi, India
| | | | - Suman S Kushwaha
- Department. of Neurology, Institute of Human Behaviour and Allied Sciences, Dilshad Garden, Delhi, India
| | - Rachna Agarwal
- Department. of Neurology, Institute of Human Behaviour and Allied Sciences, Dilshad Garden, Delhi, India
| | - Sangeeta Sharma
- Department. of Neurology, Institute of Human Behaviour and Allied Sciences, Dilshad Garden, Delhi, India
| | - Ritushree Kukreti
- Genomics and Molecular Medicine Unit, Institute of Genomics and Integrative Biology (IGIB), Council of Scientific and Industrial Research (CSIR), Delhi 110007, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Bibhu Biswal
- Cluster Innovation Centre, University of Delhi, Delhi, India.
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Tomson T, Zelano J, Dang YL, Perucca P. The pharmacological treatment of epilepsy in adults. Epileptic Disord 2023; 25:649-669. [PMID: 37386690 DOI: 10.1002/epd2.20093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/18/2023] [Accepted: 06/24/2023] [Indexed: 07/01/2023]
Abstract
The pharmacological treatment of epilepsy entails several critical decisions that need to be based on an individual careful risk-benefit analysis. These include when to initiate treatment and with which antiseizure medication (ASM). With more than 25 ASMs on the market, physicians have opportunities to tailor the treatment to individual patients´ needs. ASM selection is primarily based on the patient's type of epilepsy and spectrum of ASM efficacy, but several other factors must be considered. These include age, sex, comorbidities, and concomitant medications to mention the most important. Individual susceptibility to adverse drug effects, ease of use, costs, and personal preferences should also be taken into account. Once an ASM has been selected, the next step is to decide on an individual target maintenance dose and a titration scheme to reach this dose. When the clinical circumstances permit, a slow titration is generally preferred since it is associated with improved tolerability. The maintenance dose is adjusted based on the clinical response aiming at the lowest effective dose. Therapeutic drug monitoring can be of value in efforts to establish the optimal dose. If the first monotherapy fails to control seizures without significant adverse effects, the next step will be to gradually switch to an alternative monotherapy, or sometimes to add another ASM. If an add-on is considered, combining ASMs with different modes of action is usually recommended. Misdiagnosis of epilepsy, non-adherence and suboptimal dosing are frequent causes of treatment failure and should be excluded before a patient is regarded as drug-resistant. Other treatment modalities, including epilepsy surgery, neuromodulation, and dietary therapies, should be considered for truly drug-resistant patients. After some years of seizure freedom, the question of ASM withdrawal often arises. Although successful in many, withdrawal is also associated with risks and the decision needs to be based on careful risk-benefit analysis.
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Affiliation(s)
- Torbjörn Tomson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Johan Zelano
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Wallenberg Center of Molecular and Translational Medicine, Gothenburg University, Gothenburg, Sweden
| | - Yew Li Dang
- Bladin-Berkovic Comprehensive Epilepsy Program, Austin Health, Melbourne, Victoria, Australia
- Epilepsy Research Centre, Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Victoria, Australia
| | - Piero Perucca
- Bladin-Berkovic Comprehensive Epilepsy Program, Austin Health, Melbourne, Victoria, Australia
- Epilepsy Research Centre, Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Victoria, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
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Doege C, Luedde M, Kostev K. Association Between Angiotensin Receptor Blocker Therapy and Incidence of Epilepsy in Patients With Hypertension. JAMA Neurol 2022; 79:1296-1302. [PMID: 36251288 PMCID: PMC9577879 DOI: 10.1001/jamaneurol.2022.3413] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/18/2022] [Indexed: 01/14/2023]
Abstract
Importance Arterial hypertension is associated with an increased incidence of epilepsy. Results from animal studies suggest that angiotensin receptor blocker (ARB) therapy could inhibit epileptic seizures. However, there is a lack of clinical data to support the use of ARB therapy in humans. Objective To assess whether ARB therapy is associated with a decreased incidence of epilepsy in patients with hypertension. Design, Setting, and Participants This cohort study obtained data from the Disease Analyzer database (IQVIA) on patients aged 18 years or older who had hypertension and at least 1 antihypertensive drug prescription. Patients were treated at 1274 general practices between January 2010 and December 2020 in Germany. Data were available for 1 553 875 patients who had been prescribed at least 1 antihypertensive drug. Patients diagnosed with epilepsy before or up to 3 months after the index date were excluded. A total of 168 612 patients were included in propensity score matching. Patients treated with 1 of 4 antihypertensive drug classes (β-blockers, ARBs, angiotensin-converting enzyme inhibitors, and calcium channel blockers [CCBs]) were matched to each other using propensity scores. Main Outcomes and Measures The main outcome of the study was the incidence of epilepsy associated with ARB therapy compared with other antihypertensive drug classes. Cox regression models were used to study the association between the incidence of epilepsy and ARBs compared with all other antihypertensive drug classes as a group. Results The study included a total of 168 612 patients, with 42 153 in each antihypertensive drug class. The mean [SD] age of patients was 62.3 [13.5] years, and 21 667 (51.4%) were women. The incidence of epilepsy within 5 years was lowest among patients treated with ARBs (0.27% at 1 year, 0.63% at 3 years, 0.99% at 5 years) and highest among patients receiving β-blockers and CCBs (0.38% for both β-blockers and CCBs at 1 year; 0.91% for β-blockers and 0.93% for CCBs at 3 years; β-blockers, 1.47%; and CCBs, 1.48% at 5 years). Angiotensin receptor blocker therapy was associated with a significantly decreased incidence of epilepsy (hazard ratio, 0.77; 95% CI, 0.65-0.90) compared with the other drug classes as a group. Conclusions and Relevance In this cohort study of patients with hypertension, ARB therapy was associated with a significantly decreased incidence of epilepsy. The findings suggest antihypertensive drugs could be used as a novel approach for preventing epilepsy in patients with arterial hypertension.
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Affiliation(s)
- Corinna Doege
- Department of Pediatric Neurology, Center of Pediatrics and Adolescent Medicine, Central Hospital Bremen, Bremen, Germany
| | - Mark Luedde
- Department of Cardiology, Christian-Albrechts-University of Kiel, Kiel, Germany
- Cardiology Practice Bremerhaven, Bremerhaven, Germany
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Munger Clary H, Josephson SA, Franklin G, Herman ST, Hopp JL, Hughes I, Meunier L, Moura LMVR, Parker-McFadden B, Pugh MJ, Schultz R, Spanaki MV, Bennett A, Baca C. Seizure Frequency Process and Outcome Quality Measures: Quality Improvement in Neurology. Neurology 2022; 98:583-590. [PMID: 35379694 DOI: 10.1212/wnl.0000000000200239] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 02/02/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Heidi Munger Clary
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - S Andrew Josephson
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Gary Franklin
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Susan T Herman
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Jennifer L Hopp
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Inna Hughes
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Lisa Meunier
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Lidia M V R Moura
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Brandy Parker-McFadden
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Mary Jo Pugh
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Rebecca Schultz
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Marianna V Spanaki
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Amy Bennett
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
| | - Christine Baca
- From the Wake Forest School of Medicine (H.M.C.), Winston-Salem, NC; Weill Institute for Neurosciences (S.A.J.), University of California San Francisco; University of Washington (G.F.), Seattle; Barrow Neurological Institute (S.T.H.), Phoenix, AZ; University of Maryland School of Medicine (J.L.H.), Baltimore; University of Rochester (I.H.), NY; Epilepsy Foundation (L.M.), Bowie, MD; Massachusetts General Hospital (L.M.V.R.M.); Harvard Medical School (L.M.V.R.M.), Boston, MA; My Epilepsy Story (B.P.-M.), Nashville, TN; University of Utah School of Medicine (M.J.P.); Veterans Affairs (M.J.P.), Salt Lake City, UT; Nelda C. Stark College of Nursing (R.S.), Texas Woman's University; Pediatric Neurology & Developmental Neuroscience (R.S.), Baylor College of Medicine/Comprehensive Epilepsy Program; Children's Hospital (R.S.), Houston, TX; Albany Medical College (M.V.S.), NY; American Academy of Neurology (A.B.), Minneapolis, MN; and Virginia Commonwealth University (C.B.), Richmond
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Machine learning models for decision support in epilepsy management: A critical review. Epilepsy Behav 2021; 123:108273. [PMID: 34507093 DOI: 10.1016/j.yebeh.2021.108273] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 12/12/2022]
Abstract
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.
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Liang X, Pang X, Zhao J, Yu L, Wu P, Li X, Wei W, Zheng J. Altered static and dynamic functional network connectivity in temporal lobe epilepsy with different disease duration and their relationships with attention. J Neurosci Res 2021; 99:2688-2705. [PMID: 34269468 DOI: 10.1002/jnr.24915] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/13/2021] [Accepted: 06/14/2021] [Indexed: 11/09/2022]
Abstract
The brain network alterations associated with temporal lobe epilepsy (TLE) progression are still unclear. The purpose of this study was to investigate altered patterns of static and dynamic functional network connectivity (sFNC and dFNC) in TLE with different durations of disease. In this study, 19 TLE patients with a disease duration of ≤5 years (TLE-SD), 24 TLE patients with a disease duration of >5 years (TLE-LD), and 21 healthy controls (HCs) underwent resting-state functional magnetic resonance imaging and attention network test. We used group independent component analysis to determine the target resting-state networks. Sliding window correlation and k-means clustering analysis methods were used to obtain different dFNC states, temporal properties, and temporal variability. We then compared sFNC and dFNC between groups and found that compared with HCs, TLE-SD patients had increased sFNC between the dorsal attention network and sensorimotor network/visual network (VN), but decreased sFNC between the inferior-posterior default mode network and VN. In the strongly connected dFNC state, TLE-SD patients spent more time, had greater mean dwell time, and showed greater inconsistent abnormal network connectivity. There was a significant negative correlation between the temporal variability of auditory network- left fronto-parietal network connectivity and orienting effect. No significant differences in sFNC and dFNC were detected between TLE-LD and HC groups. These findings suggest that the damage and functional brain network abnormalities gradually occur in TLE patients after the onset of epilepsy, which might lead to functional network reorganization and compensatory remodeling as the disease progresses.
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Affiliation(s)
- Xiulin Liang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiaomin Pang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jingyuan Zhao
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lu Yu
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Peirong Wu
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xinrong Li
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Wutong Wei
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jinou Zheng
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Feely A, Lim LS, Jiang D, Lix LM. A population-based study to develop juvenile arthritis case definitions for administrative health data using model-based dynamic classification. BMC Med Res Methodol 2021; 21:105. [PMID: 33993875 PMCID: PMC8127203 DOI: 10.1186/s12874-021-01296-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous research has shown that chronic disease case definitions constructed using population-based administrative health data may have low accuracy for ascertaining cases of episodic diseases such as rheumatoid arthritis, which are characterized by periods of good health followed by periods of illness. No studies have considered a dynamic approach that uses statistical (i.e., probability) models for repeated measures data to classify individuals into disease, non-disease, and indeterminate categories as an alternative to deterministic (i.e., non-probability) methods that use summary data for case ascertainment. The research objectives were to validate a model-based dynamic classification approach for ascertaining cases of juvenile arthritis (JA) from administrative data, and compare its performance with a deterministic approach for case ascertainment. METHODS The study cohort was comprised of JA cases and non-JA controls 16 years or younger identified from a pediatric clinical registry in the Canadian province of Manitoba and born between 1980 and 2002. Registry data were linked to hospital records and physician billing claims up to 2018. Longitudinal discriminant analysis (LoDA) models and dynamic classification were applied to annual healthcare utilization measures. The deterministic case definition was based on JA diagnoses in healthcare use data anytime between birth and age 16 years; it required one hospitalization ever or two physician visits. Case definitions based on model-based dynamic classification and deterministic approaches were assessed on sensitivity, specificity, and positive and negative predictive values (PPV, NPV). Mean time to classification was also measured for the former. RESULTS The cohort included 797 individuals; 386 (48.4 %) were JA cases. A model-based dynamic classification approach using an annual measure of any JA-related healthcare contact had sensitivity = 0.70 and PPV = 0.82. Mean classification time was 9.21 years. The deterministic case definition had sensitivity = 0.91 and PPV = 0.92. CONCLUSIONS A model-based dynamic classification approach had lower accuracy for ascertaining JA cases than a deterministic approach. However, the dynamic approach required a shorter duration of time to produce a case definition with acceptable PPV. The choice of methods to construct case definitions and their performance may depend on the characteristics of the chronic disease under investigation.
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Affiliation(s)
- Allison Feely
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Canada
| | - Lily Sh Lim
- Department of Paediatrics, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Depeng Jiang
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, S113-750 Bannatyne Avenue, R3E 0W3, Winnipeg, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, S113-750 Bannatyne Avenue, R3E 0W3, Winnipeg, Canada.
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Lin CH, Chou IC, Hong SY. Genetic factors and the risk of drug-resistant epilepsy in young children with epilepsy and neurodevelopment disability: A prospective study and updated meta-analysis. Medicine (Baltimore) 2021; 100:e25277. [PMID: 33761731 PMCID: PMC8049163 DOI: 10.1097/md.0000000000025277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 03/03/2021] [Indexed: 11/26/2022] Open
Abstract
Drug-resistant epilepsy (DRE) affects 7% to 20% of children with epilepsy. Although some risk factors for DRE have been identified, the results have not been consistent. Moreover, data regarding the risk factors for epilepsy and its seizure outcome in the first 2 years of life are limited.We analyzed data for children aged 0 to 2 years with epilepsy and neurodevelopmental disability from January, 2013, through December, 2017. These patients were followed up to compare the risk of DRE in patients with genetic defect (genetic group) with that without genetic defect (nongenetic group). Additionally, we conducted a meta-analysis to identify the pooled prevalence of genetic factors in children with DRE.A total of 96 patients were enrolled. A total of 68 patients were enrolled in the nongenetic group, whereas 28 patients were enrolled in the genetic group. The overall DRE risk in the genetic group was 6.5 times (95% confidence interval [CI], 2.15-19.6; p = 0.03) higher than that in the nongenetic group. Separately, a total of 1308 DRE patients were participated in the meta-analysis. The pooled prevalence of these patients with genetic factors was 22.8% (95% CI 17.4-29.3).The genetic defect plays a crucial role in the development of DRE in younger children with epilepsy and neurodevelopmental disability. The results can serve as a reference for further studies of epilepsy panel design and may also assist in the development of improved treatments and prevention strategies for DRE.
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Affiliation(s)
- Chien-Heng Lin
- Division of Pediatrics Pulmonology, China Medical University, Children's Hospital, Taichung, Taiwan
- Department of Biomedical Imaging and Radiological Science, College of Medicine, China Medical University
| | - I-Ching Chou
- Division of Pediatrics Neurology, China Medical University, Children's Hospital
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Syuan-Yu Hong
- Division of Pediatrics Neurology, China Medical University, Children's Hospital
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9
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Brain angiotensin system: a new promise in the management of epilepsy? Clin Sci (Lond) 2021; 135:725-730. [PMID: 33729497 DOI: 10.1042/cs20201296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/03/2021] [Accepted: 03/08/2021] [Indexed: 12/30/2022]
Abstract
Epilepsy is a highly prevalent neurological disease and anti-epileptic drugs (AED) are almost the unique clinical treatment option. A disbalanced brain renin-angiotensin system (RAS) has been proposed in epilepsy and several reports have shown that angiotensin II (Ang II) receptor-1 (ATR1) activation is pro-inflammatory and pro-epileptogenic. In agreement, ATR1 blockage with the repurposed drug losartan has shown benefits in animal models of epilepsy. Processing of Ang II by ACE2 enzyme renders Ang-(1-7), a metabolite that activates the mitochondrial assembly (Mas) receptor (MasR) pathway. MasR activation presents beneficial effects, facilitating vasodilatation, increasing anti-inflammatory and antioxidative responses. In a recent paper published in Clinical Science, Gomes and colleagues (Clin. Sci. (Lond.) (2020) 134, 2263-2277) performed intracerebroventricular (icv) infusion of Ang-(1-7) in animals subjected to the pilocarpine model of epilepsy, starting after the first spontaneous motor seizure (SMS). They showed that this approach reduced the frequency of SMS, restored animal anxiety, increased exploration, and augmented the hippocampal expression of protective catalase enzyme and antiapoptotic protein B-cell lymphoma 2 (Bcl-2). Interestingly, but surprisingly, Gomes and colleagues showed that MasR expression and mTor activity were reduced in the hippocampus of the epileptic Ang-(1-7) treated animals. These results show that Ang-(1-7) administration could represent a new avenue for developing strategies for the management of epilepsy in clinical settings. However, future work is necessary to evaluate the levels of RAS metabolites and the activity of key enzymes in these experimental interventions to completely understand the therapeutic potential of the brain RAS manipulation in epilepsy.
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Rosenfeld WE, Nisman A, Ferrari L. Efficacy of adjunctive cenobamate based on number of concomitant antiseizure medications, seizure frequency, and epilepsy duration at baseline: A post-hoc analysis of a randomized clinical study. Epilepsy Res 2021; 172:106592. [PMID: 33662894 DOI: 10.1016/j.eplepsyres.2021.106592] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/28/2021] [Accepted: 02/16/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND In an 18-week, double-blind, placebo-controlled study (YKP3089C017; NCT01866111), cenobamate was effective for the treatment of focal-onset seizures. This post-hoc analysis examined the effects of baseline clinical features on the efficacy of adjunctive cenobamate during the study. METHODS Adults with uncontrolled focal seizures despite treatment with 1-3 antiepileptic drugs/antiseizure medications (AEDs/ASMs) were randomized 1:1:1:1 to placebo or cenobamate 100, 200, or 400 mg once daily. Median percent seizure frequency reduction/28 days and ≥50% responder rates were assessed during the 12-week maintenance phase (n = 397) by number of baseline (concomitant) ASMs (1, 2, >2), median baseline seizure frequency/28 days (≤9.5 vs >9.5), and median baseline duration of epilepsy (≤23 vs >23 years). RESULTS For patients taking 1 concomitant ASM, median percent seizure frequency reductions ranged from 44.7% to 86.0% for cenobamate-treated patients vs 24.1% for placebo; for 2 concomitant ASMs, reductions were 41.4-57.9% with cenobamate vs 33.3% for placebo; and for >2 concomitant ASMs, reductions were 41.5-67.4% with cenobamate vs 26.4% for placebo. The highest reductions occurred in the 200- and 400-mg/day cenobamate groups. For patients with baseline seizure frequency ≤9.5, the greatest reduction in median percent seizure frequency occurred in the 200-mg/day cenobamate group (66.5%); for patients with baseline seizure frequency >9.5 the greatest reduction occurred in the 400-mg/day cenobamate group (70.7%). Similar improvements were observed when assessed by median duration of epilepsy at baseline. For cenobamate-treated patients taking 1, 2, or >2 ASMs respectively, ≥50% responder rates of up to 66.7% (400 mg), 62.2% (200 mg), and 66.0% (400 mg) were observed, vs 20.0%, 29.3%, and 23.9% for placebo, respectively; 100% seizure reductions were observed in up to 25.0% (400 mg/day), 22.2% (400 mg/day), and 19.1% (400 mg/day) of cenobamate-treated patients, vs 0%, 0%, and 2.2% for placebo, respectively. Incidence of common (≥10%) central nervous system adverse events (dizziness, somnolence, fatigue, and diplopia) were highest in the >2 ASM group, but the rates were within the range reported in the primary study. CONCLUSIONS Clinically relevant reductions in seizure frequency including 100% seizure reductions occurred with adjunctive cenobamate regardless of number of concomitant ASMs, baseline seizure frequency, or disease duration. The greatest reductions occurred in the 200- and 400-mg/day groups.
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Affiliation(s)
- William E Rosenfeld
- Comprehensive Epilepsy Care Center for Children and Adults, 11134 Conway Road, 63131 St. Louis, MO, USA.
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11
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Liang X, Pang X, Liu J, Zhao J, Yu L, Zheng J. Comparison of topological properties of functional brain networks with graph theory in temporal lobe epilepsy with different duration of disease. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1503. [PMID: 33313248 PMCID: PMC7729351 DOI: 10.21037/atm-20-6823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Our study was performed to measure the alterations in topological properties of the functional brain network of temporal lobe epilepsy (TLE) at different durations, exploring the potential progression and neuropathophysiological mechanisms of TLE. Methods Fifty-eight subjects, including 17 TLE patients with a disease duration of ≤5 years (TLE-SD), 20 TLE patients with a disease duration of >5 years (TLE-LD), and 21 healthy controls firstly underwent the Attention Network Test (ANT) to assess the alertness function and received the resting-state functional magnetic resonance imaging (rs-fMRI). Next, a functional brain network was set up, and then the related graph of theoretical network analysis was conducted. Finally, the correlation between network property and the neuropsychological score was analyzed. Results The global and local efficiencies of functional brain networks in TLE-SD patients significantly decreased and tended toward random alterations. Also, the degree centrality (DC) and nodal efficiency (Ne) in right medial pre-frontal thalamus (mPFtha) and right rostral temporal thalamus (rTtha) of TLE-SD patients significantly reduced. Further analysis showed that alertness was positively associated with the characteristic path length but negatively related to the global and local efficiencies in TLE-SD patients; alertness was negatively related to the Ne of mPFtha in TLE-LD patients. Conclusions Our study showed that the functional brain network of TLE patients might undergo compensatory reorganization as the disease progresses, which provides useful insights into the progression and mechanism of TLE.
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Affiliation(s)
- Xiulin Liang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiaomin Pang
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jinping Liu
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jingyuan Zhao
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lu Yu
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jinou Zheng
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Medication Beliefs and Adherence to Antiseizure Medications. Neurol Res Int 2020; 2020:6718915. [PMID: 33163231 PMCID: PMC7604606 DOI: 10.1155/2020/6718915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/01/2020] [Accepted: 09/30/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction The primary objective of our study was to determine the nature of medication beliefs and their association with adherence to antiseizure medications (ASMs) among elderly epilepsy patients. Our secondary objective was to enhance the psychometric properties and factor structure parameters of the Beliefs about Medications Questionnaire (BMQ) adapted to epilepsy and affected aged subjects. Methods A population-based survey was performed in which older adults (≥60 years of age) were invited for a free face-to-face consultation with the specialists as well as for the collection of necessary data. The eligible subjects were those who are affected with epilepsy and having epileptic seizures of any type. In addition, the participants were required to be of any sex, currently under treatment with ASMs, resident of Tehran, and able and interested to participate independently. All were carefully examined with a reasonably detailed case-history examination. Two Persian questionnaires used were Medication Adherence Rating Scale (MARS) and BMQ. Those with a MARS score of ≥6 were considered as adherent to ASMs. All data were described in descriptive terms. We did a group comparison of means and proportions for all possible independent variables between adherents and nonadherents. Then, we did a hierarchical multiple linear regression. For this, independent variables were categorized into three different blocks: (a) sociodemographic block (Block-1), (b) treatment side-effect block (Block-2), and (c) BMQ block that included ten items of the BMQ scale (Block-3). We also did a forward step-wise linear regression by beginning with an empty model. We also estimated the psychometric properties and factor structure parameters of BMQ and its two subdomains. Results Of all (N = 123, mean age: 63.3 years, 74.0% males), 78.0% were adherent (mean score: 7.0, 95% CI 6.2–7.8) to ASMs. The MARS scores were not different between males and females. The mean BMQ score was 23.4 (95% CI 19.8–27.0) with the mean need score of 20.0 (95% CI 18.0–22.0) and mean concern score of 16.5 (95% CI 14.3–18.7). A positive need-concern differential was 20.4%. Upon hierarchical regression, the adjusted R2 for Block-1 was 33.8%, and it was 53.8% for Block-2 and 92.2% for Block-3. Upon forward step-wise linear regression, we found that “ASMs disrupt my life” (ß −1.9, ES = −1.1, p=0.008) as the only belief associated with adherence. The alpha coefficient of BMQ was 0.81. Conclusions Ours is one of the very few studies that evaluated medication beliefs and their association with adherence to ASMs among elderly epilepsy patients in a non-western context. In our context, medication beliefs are likely to have an independent role in effecting adherence to ASMs, particularly the concern that “ASMs disrupt life.” Treating physicians should cultivate good conscience about ASMs and evaluate the patient's medication beliefs early-on to identify those who might be at the risk of becoming nonadherent.
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Caprara ALF, Rissardo JP, Leite MTB, Silveira JOF, Jauris PGM, Arend J, Kegler A, Royes LFF, Fighera MR. Course and prognosis of adult-onset epilepsy in Brazil: A cohort study. Epilepsy Behav 2020; 105:106969. [PMID: 32113113 DOI: 10.1016/j.yebeh.2020.106969] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Most of the epilepsy longitudinal studies have analyzed children. However, in endemic regions, such as Brazil, neurocysticercosis accounts for many adult-onset epilepsy cases. So, the main objective of this study was to identify the clinical predictors associated with drug-resistant adult-onset epilepsy in Brazil during a long-term follow-up. METHODS We followed 302 individuals with adult-onset epilepsy for 9.8 years in our University Hospital. Structured questionnaires about drug-resistant epilepsy were applied. The presence of drug-resistant epilepsy was the primary outcome. We used multilevel linear modeling in our data analysis. RESULTS Overall 47 (15.6%) individuals presented drug-resistant epilepsy and the etiology was structural in 70.2% of them, while infectious etiology was present in 8.5% of this group. Infectious etiology occurred in 25.9% (n = 66) of the patients from the nondrug-resistant group. Those with developmental delay were two times more likely to present seizures. Structural epilepsy etiology was associated with an increased chance of relapsing. Poor school performance and abnormal electroencephalogram were also associated with an increased chance of seizures. CONCLUSION The course of epilepsy was favorable in the majority of our patients, and drug-resistant epilepsy rates were similar to those found in other studies, although we evaluated older individuals with higher levels of infectious etiology. Also, we found that neurocysticercosis was associated with well-controlled epilepsy, while structural epilepsy was directly related to the occurrence of seizures. We also hypothesized that the smaller size of lesions found in neurocysticercosis could contribute to better treatment response.
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Affiliation(s)
- Ana Letícia F Caprara
- Health Sciences Center, Department of Neuropsychiatry, Federal University of Santa Maria, RS, Brazil.
| | - Jamir P Rissardo
- Health Sciences Center, Department of Neuropsychiatry, Federal University of Santa Maria, RS, Brazil
| | - Martim T B Leite
- Health Sciences Center, Department of Neuropsychiatry, Federal University of Santa Maria, RS, Brazil
| | - Juliana O F Silveira
- Health Sciences Center, Department of Neuropsychiatry, Federal University of Santa Maria, RS, Brazil
| | - Paulo G M Jauris
- Health Sciences Center, Department of Neuropsychiatry, Federal University of Santa Maria, RS, Brazil
| | - Josi Arend
- Health Sciences Center, Postgraduate Program in Pharmacology, Federal University of Santa Maria, RS, Brazil
| | - Aline Kegler
- Center for Natural and Exact Sciences, Postgraduate Program in Biological Sciences: Toxicological Biochemistry, Federal University of Santa Maria, RS, Brazil
| | - Luiz Fernando Freire Royes
- Physical Education and Sports Center, Exercise Biochemistry Laboratory (BIOEX), Federal University of Santa Maria, RS, Brazil
| | - Michele Rechia Fighera
- Health Sciences Center, Department of Neuropsychiatry, Federal University of Santa Maria, RS, Brazil
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Gharagozli K, Lotfalinezhad E, Amini F, Saii V, Bhalla D. Evaluation of Fear in Idiopathic Epilepsy Using Population-Based Survey and Bhalla-Gharagozli Fear in Epilepsy Questionnaire (BG-FEQ). Neuropsychiatr Dis Treat 2020; 16:1685-1693. [PMID: 32764944 PMCID: PMC7360404 DOI: 10.2147/ndt.s248785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/28/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The primary objective of this study was to evaluate fear related to epilepsy and its treatment among those with idiopathic epilepsy. Our secondary objective was to estimate the psychometric properties of a brief Bhalla-Gharagozli Fear in epilepsy Questionnaire (BG-FEQ). METHODS We conducted patient-finding exercise in our study areas through various means to obtain subjects with idiopathic epilepsy. We carefully examined each patient through a detailed case-history examination. Following that, we evaluated fear related to epilepsy by using Bhalla-Gharagozli Fear in Epilepsy Questionnaire (BG-FEQ) across two broad domains: epilepsy and pharmacotherapy. RESULTS The study obtained 52 subjects (39.0 years; 45.0% males, 70.0% married, 35.0% unqualified, 85.0% active epilepsy, 80.0% generalized seizures) with idiopathic epilepsy. The alpha coefficient was 92.8, with no item-specific coefficient of ≤0.91. The alpha coefficient was 0.90 and 0.93 for reporting a "yes" and "no" to the items, respectively. We obtained a two-factor structure of BG-FEQ that provided a cumulative variance of 83.6%. The majority (65.0%) reported at least one fear. The per-patient mean number of the fear element was 2.1 (95% CI 1.1-3.3), which differed significantly for males and females (1.1, 95% CI 0.4-2.6 and 3.0, 95% CI 1.4-4.6, respectively, p=0.03). The most frequent fear was that of addiction and the bad effects of anti-seizure medications (both 45.0%). Upon bootstrap regression after constraining gender, the fear elements were associated with illiteracy, difficulty in understanding epilepsy and sleeping in a prone position. The sample power was 99.0%. CONCLUSION There was a significant representation of fear among those with idiopathic epilepsy, especially among the females, particularly the fear of brain tumour, premature death and more frequent/severe seizures over time. At least 65.0% of idiopathic subjects are likely to be affected by at least one fear. The essential mitigating approach should be the education of practitioners towards better identification and therapeutic handling of comorbid constructs, and also for the education of patients and their caregivers towards better awareness and prevention. There is also a need for formal Epilepsy Educators towards better awareness, therapeutic support and prevention of epilepsy.
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Affiliation(s)
- Kurosh Gharagozli
- Iran Epilepsy Association, Tehran, Iran.,Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Brain Mapping Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Lotfalinezhad
- Department of Health Education and Promotion, Tabriz University of Medical Sciences, Tabriz, Iran.,Iranian Research Centre on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fatemeh Amini
- Iranian Research Centre on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Vida Saii
- Iran Epilepsy Association, Tehran, Iran
| | - Devender Bhalla
- Nepal Interest Group of Epilepsy and Neurology (NiGEN), Kathmandu, Nepal.,Sudan League of Epilepsy and Neurology (SLeN), Khartoum, Sudan.,Pôle Universitaire Euclide Intergovernmental UN Treaty 49006/49007, Bangui, Central African Republic
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15
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Lee BI, Park KM, Kim SE, Heo K. Clinical opinion: Earlier employment of polytherapy in sequential pharmacotherapy of epilepsy. Epilepsy Res 2019; 156:106165. [PMID: 31351239 DOI: 10.1016/j.eplepsyres.2019.106165] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/07/2019] [Indexed: 01/22/2023]
Abstract
Modern pharmacotherapy for epilepsy consists of orderly, sequential drug trials, in which antiepileptic drugs (AEDs) are chosen under the concept of individual patient-oriented (or - tailored) pharmacotherapy. Although monotherapy has been established as the preferred mode of AEDs therapy in both newly diagnosed and drug resistant epilepsies, there are still lack of evidence to favor either monotherapy or polytherapy in epilepsy, which has generated continuing controversies on the preferred mode of pharmacotherapy. However, each mode of pharmacotherapy may have both advantages and disadvantages, which are different and variable related to individual case scenario. We conducted a brief comparative overview between monotherapy and polytherapy to provide clues for earlier employment of polytherapy in each steps of sequential drug trials. Previous claims about the advantages of monotherapy over polytherapy are not supported but gradually losing its ground by the introduction of a large number of drugs carrying pharmacological advantages for combination therapy. Current evidence stresses the importance of combining drugs having synergistic interactions for better outcome of polytherapy, which has not been considered in previous clinical investigations comparing monotherapy and polytherapy. It is likely that a significant improvement in the outcome of current AEDs therapy is feasible by earlier employment of polytherapy as well as identification of combination drug regimens carrying synergistic interactions. At present, lamotrigine(LTG) and valproate(VPA) combination regimen is the only well documented synergistic regimen, but there are a long-list of candidate regimens requiring future trials in appropriate designs.
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Affiliation(s)
- Byung In Lee
- Department of Neurology and Epilepsy Center, Inje University Haeundae Paik Hospital, Busan, Republic of Korea.
| | - Kang Min Park
- Department of Neurology and Epilepsy Center, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Sung Eun Kim
- Department of Neurology and Epilepsy Center, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Kyoung Heo
- Department of Neurology, Yonsei University College of Medicine, Severance Hospital, Epilepsy Research Institute, Seoul, Republic of Korea
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Yao L, Cai M, Chen Y, Shen C, Shi L, Guo Y. Prediction of antiepileptic drug treatment outcomes of patients with newly diagnosed epilepsy by machine learning. Epilepsy Behav 2019; 96:92-97. [PMID: 31121513 DOI: 10.1016/j.yebeh.2019.04.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/22/2019] [Accepted: 04/07/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this study was to build a supervised machine learning-based classifier, which can accurately predict the outcomes of antiepileptic drug (AED) treatment of patients with newly diagnosed epilepsy. METHODS We collected information from 287 patients with newly diagnosed epilepsy between 2009 and 2017 at the Second Affiliated Hospital of Zhejiang University. Patients were prospectively followed up for at least 3 years. A number of features, including demographic features, medical history, and auxiliary examinations (electroencephalogram [EEG] and magnetic resonance imaging [MRI]) are selected to distinguish patients with different remission outcomes. Seizure outcomes classified as remission and never remission. In addition, remission is further divided into early remission and late remission. Five classical machine learning algorithms, i.e., Decision Tree, Random Forest, Support Vector Machine, XGBoost, and Logistic Regression, are selected and trained by our dataset to get classification models. RESULTS Our study shows that 1) compared with the other four algorithms, the XGBoost algorithm based machine learning model achieves the best prediction performance of the AED treatment outcomes between remission and never remission patients with an F1 score of 0.947 and an area under the curve (AUC) value of 0.979; 2) The best discriminative factor for remission and never remission patients is higher number of seizures before treatment (>3); 3) XGBoost-based machine learning model also offers the best prediction between early remission and later remission patients, with an F1 score of 0.836 and an AUC value of 0.918; 4) multiple seizure type has the highest dependence to the categories of early and late remission patients. SIGNIFICANCES Our XGBoost-based machine learning classifier accurately predicts the most probable AED treatment outcome of a patient after he/she finishes all the standard examinations for the epilepsy disease. The classifier's prediction result could help disease guide counseling and eventually improve treatment strategies.
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Affiliation(s)
- Lijun Yao
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai 200124, PR China.
| | - Mengting Cai
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang, PR China
| | - Yang Chen
- School of Computer Science, Fudan University, Shanghai 201203, PR China
| | - Chunhong Shen
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang, PR China
| | - Lei Shi
- The State Key Laboratory of Computer Science, Institute of Software, Chinese Academy of Sciences, Beijing 100080, PR China
| | - Yi Guo
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang, PR China.
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Hughes DM, Bonnett LJ, Marson AG, García-Fiñana M. Identifying patients who will not reachieve remission after breakthrough seizures. Epilepsia 2019; 60:774-782. [PMID: 30900756 PMCID: PMC6487810 DOI: 10.1111/epi.14697] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 03/01/2019] [Accepted: 03/01/2019] [Indexed: 11/29/2022]
Abstract
Objective We aim to identify people with epilepsy who are unlikely to reachieve a 12‐month remission within 2 years after experiencing a breakthrough seizure following an initial 12‐month remission. Methods We apply a novel longitudinal discriminant approach to data from the Standard and New Antiepileptic Drugs study to dynamically predict the risk of a patient not achieving a second remission after a breakthrough seizure by combining both baseline covariates (collected at the time of breakthrough seizure) and follow‐up data. Results The model classifies 83% of patients. Of these, 73% of patients (95% confidence interval [CI] = 58%‐88%) who did not achieve a second remission were correctly identified (sensitivity), and 84% of patients (95% CI = 69%‐96%) who achieved a second remission were correctly identified (specificity). The area under the curve from our model was 87% (95% CI = 80%‐94%). Patients who did not achieve a second remission were correctly identified on average after 10 months of observation postbreakthrough. Occurrence of seizures after breakthrough and the number of seizures experienced were the most informative longitudinal variables. These longitudinal profiles were influenced by the following baseline covariates: age at breakthrough seizure, presence of neurological insult, and number of antiepileptic drugs required to achieve first remission. Significance Using longitudinal data gathered during patient follow‐up allows more accurate predictions than using baseline covariates in a standard Cox model. The model developed in this paper is a useful first step in developing a tool for identifying patients who develop drug resistance after an initial remission.
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Affiliation(s)
- David M Hughes
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Laura J Bonnett
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Anthony G Marson
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,The Walton Centre NHS Foundation Trust, members of Liverpool Health Partners, Liverpool, UK
| | - Marta García-Fiñana
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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What's happening in Innovations in Care Delivery. Neurology 2019. [DOI: 10.1212/wnl.0000000000006753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Faught E. Balancing reality with hope in epilepsy therapy. Neurology 2018; 91:989-990. [DOI: 10.1212/wnl.0000000000006561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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