Risk of seizure recurrence in people with single seizures and early epilepsy - Model development and external validation.
Risk of seizure recurrence in people with single seizures and early epilepsy - Model development and external validation.
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DOI：
10.1016/j.seizure.2021.11.007
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发表时间：
2022-01
期刊：
影响因子：
--
通讯作者：
Marson AG
中科院分区：
文献类型：
--
作者：
Bonnett LJ;Kim L;Johnson A;Sander JW;Lawn N;Beghi E;Leone M;Marson AG
模型预测单次发作或癫痫诊断后癫痫发作复发的风险。模型在独立数据中表现良好。未来的工作需要确保该模型在临床实践中得到采用。该模型可以改善单次癫痫发作和早期癫痫患者的生活。在单次癫痫发作或近期癫痫诊断后，很难平衡药物副作用的风险与预防癫痫复发的潜力。开发并验证了一个预测模型，使风险分层，从而为治疗决策和个性化咨询提供信息。来自随机对照试验的数据用于开发首次癫痫发作或癫痫诊断后癫痫发作复发风险的预测模型。通过考克斯比例风险回归对至事件发生时间数据进行建模。通过使用原始数据集和三个外部数据集-国家癫痫全科医学调查（NGPSE），西澳大利亚首次癫痫发作数据库（WA）和FIRST（意大利首次强直阵挛性癫痫发作患者数据集）的区分和校准来评估模型有效性。患有神经功能缺损、局灶性癫痫发作、脑电图异常、不适合CT/MRI扫描或未立即治疗的患者癫痫复发的风险显著较高。在所有数据集中，歧视是公平和一致的（c-统计量：0.555（NGPSE）; 0.558（WA）; 0.597（FIRST））。校准图显示，在NGPSE在一年和三年的观测和预测概率之间的良好协议。WA和FIRST的图显示与模型的一致性较差，在WA中预测风险不足，在FIRST中预测过度。模型重新校准后，这一问题得到了解决。该模型在独立数据中表现良好，特别是在重新校准时。它现在应该用于临床实践，因为它可以通过有针对性的治疗选择和更知情的患者咨询来改善单次癫痫发作和早期癫痫患者的生活。
Model predicts risk of seizure recurrence after single fit or epilepsy diagnosis. Model performs well in independent data. Future work required to ensure the model is adopted in clinical practice. Model can improve the lives of people with single seizures and early epilepsy. 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. 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). 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. 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.
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