Abstract
ObjectiveTo identify people with epilepsy who will not achieve a 12-month seizure remission within 5 years of starting treatment.MethodsThe 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.ResultsChanges 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.ConclusionOur 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.
Highlights
The Standard and New Antiepileptic Drug (SANAD) study is the largest prospective study in patients with epilepsy to date
Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article
Arm A included those for whom carbamazepine was considered the first-line standard treatment, primarily patients with focal epilepsy, who were randomized to treatment with carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate
Summary
The Standard and New Antiepileptic Drug (SANAD) study is the largest prospective study in patients with epilepsy to date. Patients and procedures The Standard and New Antiepileptic Drugs (SANAD) trial[11,12] is a randomized controlled trial that recruited 2,437 people with epilepsy assigned to 1 of 2 arms of the trial. Arm B included those for whom sodium valproate was considered the first-line standard treatment, primarily those with generalized or unclassified epilepsy, who were randomized to lamotrigine, topiramate, or valproate. Clinicians recruiting patients into SANAD were primarily neurologists with expertise in epilepsy This dataset contains a large, heterogeneous group of patients with epilepsy, many of whom have been observed for at least 5 years, and provides the opportunity to investigate the individual profiles of patients to predict those who will not achieve a 12-month continuous seizure remission during follow-up. To account for this uncertainty, credible intervals (bayesian equivalent of confidence intervals [CIs], an interval in which we are 99% confident that the true probability of not achieving remission during 5 years lies) were used to assess the confidence in the assigned risk.[21]
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