Predictive models for starting antiseizure medication withdrawal following epilepsy surgery in adults
Abstract More than half of adults with epilepsy undergoing resective epilepsy surgery achieve long-term seizure freedom and might consider withdrawing antiseizure medications. We aimed to identify predictors of seizure recurrence after starting postoperative antiseizure medication withdrawal and dev...
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| Veröffentlicht in: | Brain (London, England : 1878) England : 1878), 2023-06, Vol.146 (6), p.2389-2398 |
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| creator | Ferreira-Atuesta, Carolina de Tisi, Jane McEvoy, Andrew W Miserocchi, Anna Khoury, Jean Yardi, Ruta Vegh, Deborah T Butler, James Lee, Hamin J Deli-Peri, Victoria Yao, Yi Wang, Feng-Peng Zhang, Xiao-Bin Shakhatreh, Lubna Siriratnam, Pakeeran Neal, Andrew Sen, Arjune Tristram, Maggie Varghese, Elizabeth Biney, Wendy Gray, William P Peralta, Ana Rita Rainha-Campos, Alexandre Gonçalves-Ferreira, António J C Pimentel, José Arias, Juan Fernando Terman, Samuel Terziev, Robert Lamberink, Herm J Braun, Kees P J Otte, Willem M Rugg-Gunn, Fergus J Gonzalez, Walter Bentes, Carla Hamandi, Khalid O’Brien, Terence J Perucca, Piero Yao, Chen Burman, Richard J Jehi, Lara Duncan, John S Sander, Josemir W Koepp, Matthias Galovic, Marian |
| description | Abstract
More than half of adults with epilepsy undergoing resective epilepsy surgery achieve long-term seizure freedom and might consider withdrawing antiseizure medications. We aimed to identify predictors of seizure recurrence after starting postoperative antiseizure medication withdrawal and develop and validate predictive models.
We performed an international multicentre observational cohort study in nine tertiary epilepsy referral centres. We included 850 adults who started antiseizure medication withdrawal following resective epilepsy surgery and were free of seizures other than focal non-motor aware seizures before starting antiseizure medication withdrawal. We developed a model predicting recurrent seizures, other than focal non-motor aware seizures, using Cox proportional hazards regression in a derivation cohort (n = 231). Independent predictors of seizure recurrence, other than focal non-motor aware seizures, following the start of antiseizure medication withdrawal were focal non-motor aware seizures after surgery and before withdrawal [adjusted hazard ratio (aHR) 5.5, 95% confidence interval (CI) 2.7–11.1], history of focal to bilateral tonic-clonic seizures before surgery (aHR 1.6, 95% CI 0.9–2.8), time from surgery to the start of antiseizure medication withdrawal (aHR 0.9, 95% CI 0.8–0.9) and number of antiseizure medications at time of surgery (aHR 1.2, 95% CI 0.9–1.6). Model discrimination showed a concordance statistic of 0.67 (95% CI 0.63–0.71) in the external validation cohorts (n = 500). A secondary model predicting recurrence of any seizures (including focal non-motor aware seizures) was developed and validated in a subgroup that did not have focal non-motor aware seizures before withdrawal (n = 639), showing a concordance statistic of 0.68 (95% CI 0.64–0.72). Calibration plots indicated high agreement of predicted and observed outcomes for both models.
We show that simple algorithms, available as graphical nomograms and online tools (predictepilepsy.github.io), can provide probabilities of seizure outcomes after starting postoperative antiseizure medication withdrawal. These multicentre-validated models may assist clinicians when discussing antiseizure medication withdrawal after surgery with their patients.
Is it safe to begin withdrawal of antiseizure medications after epilepsy surgery? Ferreira-Atuesta et al. develop and validate models to predict seizure relapse after postoperative initiation of antiseizure medication withdrawal |
| doi_str_mv | 10.1093/brain/awac437 |
| format | Article |
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More than half of adults with epilepsy undergoing resective epilepsy surgery achieve long-term seizure freedom and might consider withdrawing antiseizure medications. We aimed to identify predictors of seizure recurrence after starting postoperative antiseizure medication withdrawal and develop and validate predictive models.
We performed an international multicentre observational cohort study in nine tertiary epilepsy referral centres. We included 850 adults who started antiseizure medication withdrawal following resective epilepsy surgery and were free of seizures other than focal non-motor aware seizures before starting antiseizure medication withdrawal. We developed a model predicting recurrent seizures, other than focal non-motor aware seizures, using Cox proportional hazards regression in a derivation cohort (n = 231). Independent predictors of seizure recurrence, other than focal non-motor aware seizures, following the start of antiseizure medication withdrawal were focal non-motor aware seizures after surgery and before withdrawal [adjusted hazard ratio (aHR) 5.5, 95% confidence interval (CI) 2.7–11.1], history of focal to bilateral tonic-clonic seizures before surgery (aHR 1.6, 95% CI 0.9–2.8), time from surgery to the start of antiseizure medication withdrawal (aHR 0.9, 95% CI 0.8–0.9) and number of antiseizure medications at time of surgery (aHR 1.2, 95% CI 0.9–1.6). Model discrimination showed a concordance statistic of 0.67 (95% CI 0.63–0.71) in the external validation cohorts (n = 500). A secondary model predicting recurrence of any seizures (including focal non-motor aware seizures) was developed and validated in a subgroup that did not have focal non-motor aware seizures before withdrawal (n = 639), showing a concordance statistic of 0.68 (95% CI 0.64–0.72). Calibration plots indicated high agreement of predicted and observed outcomes for both models.
We show that simple algorithms, available as graphical nomograms and online tools (predictepilepsy.github.io), can provide probabilities of seizure outcomes after starting postoperative antiseizure medication withdrawal. These multicentre-validated models may assist clinicians when discussing antiseizure medication withdrawal after surgery with their patients.
Is it safe to begin withdrawal of antiseizure medications after epilepsy surgery? Ferreira-Atuesta et al. develop and validate models to predict seizure relapse after postoperative initiation of antiseizure medication withdrawal in adults. The models are available online at predictepilepsy.github.io.</description><identifier>ISSN: 0006-8950</identifier><identifier>EISSN: 1460-2156</identifier><identifier>DOI: 10.1093/brain/awac437</identifier><identifier>PMID: 36415957</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Adult ; Anticonvulsants - adverse effects ; Epilepsies, Partial ; Epilepsy - drug therapy ; Epilepsy - surgery ; Epilepsy, Generalized - drug therapy ; Humans ; Neoplasm Recurrence, Local - drug therapy ; Seizures - drug therapy</subject><ispartof>Brain (London, England : 1878), 2023-06, Vol.146 (6), p.2389-2398</ispartof><rights>The Author(s) 2022. Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 2022</rights><rights>The Author(s) 2022. Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c365t-36b8740efce2082142bf067366f2a14ad2dd823a117db3e7c967a968e2f45fd93</citedby><cites>FETCH-LOGICAL-c365t-36b8740efce2082142bf067366f2a14ad2dd823a117db3e7c967a968e2f45fd93</cites><orcidid>0000-0002-4277-8000 ; 0000-0003-3107-7871 ; 0000-0002-1373-0681 ; 0000-0002-8041-6377 ; 0000-0002-7855-7066 ; 0000-0001-6041-9661 ; 0000-0001-7595-8887 ; 0000-0003-0853-7163 ; 0000-0002-2307-071X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36415957$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ferreira-Atuesta, Carolina</creatorcontrib><creatorcontrib>de Tisi, Jane</creatorcontrib><creatorcontrib>McEvoy, Andrew W</creatorcontrib><creatorcontrib>Miserocchi, Anna</creatorcontrib><creatorcontrib>Khoury, Jean</creatorcontrib><creatorcontrib>Yardi, Ruta</creatorcontrib><creatorcontrib>Vegh, Deborah T</creatorcontrib><creatorcontrib>Butler, James</creatorcontrib><creatorcontrib>Lee, Hamin J</creatorcontrib><creatorcontrib>Deli-Peri, Victoria</creatorcontrib><creatorcontrib>Yao, Yi</creatorcontrib><creatorcontrib>Wang, Feng-Peng</creatorcontrib><creatorcontrib>Zhang, Xiao-Bin</creatorcontrib><creatorcontrib>Shakhatreh, Lubna</creatorcontrib><creatorcontrib>Siriratnam, Pakeeran</creatorcontrib><creatorcontrib>Neal, Andrew</creatorcontrib><creatorcontrib>Sen, Arjune</creatorcontrib><creatorcontrib>Tristram, Maggie</creatorcontrib><creatorcontrib>Varghese, Elizabeth</creatorcontrib><creatorcontrib>Biney, Wendy</creatorcontrib><creatorcontrib>Gray, William P</creatorcontrib><creatorcontrib>Peralta, Ana Rita</creatorcontrib><creatorcontrib>Rainha-Campos, Alexandre</creatorcontrib><creatorcontrib>Gonçalves-Ferreira, António J C</creatorcontrib><creatorcontrib>Pimentel, José</creatorcontrib><creatorcontrib>Arias, Juan Fernando</creatorcontrib><creatorcontrib>Terman, Samuel</creatorcontrib><creatorcontrib>Terziev, Robert</creatorcontrib><creatorcontrib>Lamberink, Herm J</creatorcontrib><creatorcontrib>Braun, Kees P J</creatorcontrib><creatorcontrib>Otte, Willem M</creatorcontrib><creatorcontrib>Rugg-Gunn, Fergus J</creatorcontrib><creatorcontrib>Gonzalez, Walter</creatorcontrib><creatorcontrib>Bentes, Carla</creatorcontrib><creatorcontrib>Hamandi, Khalid</creatorcontrib><creatorcontrib>O’Brien, Terence J</creatorcontrib><creatorcontrib>Perucca, Piero</creatorcontrib><creatorcontrib>Yao, Chen</creatorcontrib><creatorcontrib>Burman, Richard J</creatorcontrib><creatorcontrib>Jehi, Lara</creatorcontrib><creatorcontrib>Duncan, John S</creatorcontrib><creatorcontrib>Sander, Josemir W</creatorcontrib><creatorcontrib>Koepp, Matthias</creatorcontrib><creatorcontrib>Galovic, Marian</creatorcontrib><title>Predictive models for starting antiseizure medication withdrawal following epilepsy surgery in adults</title><title>Brain (London, England : 1878)</title><addtitle>Brain</addtitle><description>Abstract
More than half of adults with epilepsy undergoing resective epilepsy surgery achieve long-term seizure freedom and might consider withdrawing antiseizure medications. We aimed to identify predictors of seizure recurrence after starting postoperative antiseizure medication withdrawal and develop and validate predictive models.
We performed an international multicentre observational cohort study in nine tertiary epilepsy referral centres. We included 850 adults who started antiseizure medication withdrawal following resective epilepsy surgery and were free of seizures other than focal non-motor aware seizures before starting antiseizure medication withdrawal. We developed a model predicting recurrent seizures, other than focal non-motor aware seizures, using Cox proportional hazards regression in a derivation cohort (n = 231). Independent predictors of seizure recurrence, other than focal non-motor aware seizures, following the start of antiseizure medication withdrawal were focal non-motor aware seizures after surgery and before withdrawal [adjusted hazard ratio (aHR) 5.5, 95% confidence interval (CI) 2.7–11.1], history of focal to bilateral tonic-clonic seizures before surgery (aHR 1.6, 95% CI 0.9–2.8), time from surgery to the start of antiseizure medication withdrawal (aHR 0.9, 95% CI 0.8–0.9) and number of antiseizure medications at time of surgery (aHR 1.2, 95% CI 0.9–1.6). Model discrimination showed a concordance statistic of 0.67 (95% CI 0.63–0.71) in the external validation cohorts (n = 500). A secondary model predicting recurrence of any seizures (including focal non-motor aware seizures) was developed and validated in a subgroup that did not have focal non-motor aware seizures before withdrawal (n = 639), showing a concordance statistic of 0.68 (95% CI 0.64–0.72). Calibration plots indicated high agreement of predicted and observed outcomes for both models.
We show that simple algorithms, available as graphical nomograms and online tools (predictepilepsy.github.io), can provide probabilities of seizure outcomes after starting postoperative antiseizure medication withdrawal. These multicentre-validated models may assist clinicians when discussing antiseizure medication withdrawal after surgery with their patients.
Is it safe to begin withdrawal of antiseizure medications after epilepsy surgery? Ferreira-Atuesta et al. develop and validate models to predict seizure relapse after postoperative initiation of antiseizure medication withdrawal in adults. The models are available online at predictepilepsy.github.io.</description><subject>Adult</subject><subject>Anticonvulsants - adverse effects</subject><subject>Epilepsies, Partial</subject><subject>Epilepsy - drug therapy</subject><subject>Epilepsy - surgery</subject><subject>Epilepsy, Generalized - drug therapy</subject><subject>Humans</subject><subject>Neoplasm Recurrence, Local - drug therapy</subject><subject>Seizures - drug therapy</subject><issn>0006-8950</issn><issn>1460-2156</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkDtPwzAURi0EoqUwsiKPLKF-xUlGVPGSKsEAc-TEN8XIjYPtUJVfT0ILjEx3uEfnkw5C55RcUVLweeWVaedqo2rBswM0pUKShNFUHqIpIUQmeZGSCToJ4Y0QKjiTx2jCpaBpkWZTBE8etKmj-QC8dhpswI3zOETlo2lXWLXRBDCfvR_-I6micS3emPiq_bBqB9xatxlZ6IyFLmxx6P0K_BabFivd2xhO0VGjbICz_Z2hl9ub58V9sny8e1hcL5OayzQmXFZ5Jgg0NTCSMypY1RCZcSkbpqhQmmmdM64ozXTFIasLmalC5sAakTa64DN0ufN23r33EGK5NqEGa1ULrg8ly3ghOKF8RJMdWnsXgoem7LxZK78tKSnHsuV32XJfduAv9uq-GkL80j8p_7Zd3_3j-gL1MIZ_</recordid><startdate>20230601</startdate><enddate>20230601</enddate><creator>Ferreira-Atuesta, Carolina</creator><creator>de Tisi, Jane</creator><creator>McEvoy, Andrew W</creator><creator>Miserocchi, Anna</creator><creator>Khoury, Jean</creator><creator>Yardi, Ruta</creator><creator>Vegh, Deborah T</creator><creator>Butler, James</creator><creator>Lee, Hamin J</creator><creator>Deli-Peri, Victoria</creator><creator>Yao, Yi</creator><creator>Wang, Feng-Peng</creator><creator>Zhang, Xiao-Bin</creator><creator>Shakhatreh, Lubna</creator><creator>Siriratnam, Pakeeran</creator><creator>Neal, Andrew</creator><creator>Sen, Arjune</creator><creator>Tristram, Maggie</creator><creator>Varghese, Elizabeth</creator><creator>Biney, Wendy</creator><creator>Gray, William P</creator><creator>Peralta, Ana Rita</creator><creator>Rainha-Campos, Alexandre</creator><creator>Gonçalves-Ferreira, António J C</creator><creator>Pimentel, José</creator><creator>Arias, Juan Fernando</creator><creator>Terman, Samuel</creator><creator>Terziev, Robert</creator><creator>Lamberink, Herm J</creator><creator>Braun, Kees P J</creator><creator>Otte, Willem M</creator><creator>Rugg-Gunn, Fergus J</creator><creator>Gonzalez, Walter</creator><creator>Bentes, Carla</creator><creator>Hamandi, Khalid</creator><creator>O’Brien, Terence J</creator><creator>Perucca, Piero</creator><creator>Yao, Chen</creator><creator>Burman, Richard J</creator><creator>Jehi, Lara</creator><creator>Duncan, John S</creator><creator>Sander, Josemir W</creator><creator>Koepp, Matthias</creator><creator>Galovic, Marian</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4277-8000</orcidid><orcidid>https://orcid.org/0000-0003-3107-7871</orcidid><orcidid>https://orcid.org/0000-0002-1373-0681</orcidid><orcidid>https://orcid.org/0000-0002-8041-6377</orcidid><orcidid>https://orcid.org/0000-0002-7855-7066</orcidid><orcidid>https://orcid.org/0000-0001-6041-9661</orcidid><orcidid>https://orcid.org/0000-0001-7595-8887</orcidid><orcidid>https://orcid.org/0000-0003-0853-7163</orcidid><orcidid>https://orcid.org/0000-0002-2307-071X</orcidid></search><sort><creationdate>20230601</creationdate><title>Predictive models for starting antiseizure medication withdrawal following epilepsy surgery in adults</title><author>Ferreira-Atuesta, Carolina ; de Tisi, Jane ; McEvoy, Andrew W ; Miserocchi, Anna ; Khoury, Jean ; Yardi, Ruta ; Vegh, Deborah T ; Butler, James ; Lee, Hamin J ; Deli-Peri, Victoria ; Yao, Yi ; Wang, Feng-Peng ; Zhang, Xiao-Bin ; Shakhatreh, Lubna ; Siriratnam, Pakeeran ; Neal, Andrew ; Sen, Arjune ; Tristram, Maggie ; Varghese, Elizabeth ; Biney, Wendy ; Gray, William P ; Peralta, Ana Rita ; Rainha-Campos, Alexandre ; Gonçalves-Ferreira, António J C ; Pimentel, José ; Arias, Juan Fernando ; Terman, Samuel ; Terziev, Robert ; Lamberink, Herm J ; Braun, Kees P J ; Otte, Willem M ; Rugg-Gunn, Fergus J ; Gonzalez, Walter ; Bentes, Carla ; Hamandi, Khalid ; O’Brien, Terence J ; Perucca, Piero ; Yao, Chen ; Burman, Richard J ; Jehi, Lara ; Duncan, John S ; Sander, Josemir W ; Koepp, Matthias ; Galovic, Marian</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c365t-36b8740efce2082142bf067366f2a14ad2dd823a117db3e7c967a968e2f45fd93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adult</topic><topic>Anticonvulsants - adverse effects</topic><topic>Epilepsies, Partial</topic><topic>Epilepsy - drug therapy</topic><topic>Epilepsy - surgery</topic><topic>Epilepsy, Generalized - drug therapy</topic><topic>Humans</topic><topic>Neoplasm Recurrence, Local - drug therapy</topic><topic>Seizures - drug therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ferreira-Atuesta, Carolina</creatorcontrib><creatorcontrib>de Tisi, Jane</creatorcontrib><creatorcontrib>McEvoy, Andrew W</creatorcontrib><creatorcontrib>Miserocchi, Anna</creatorcontrib><creatorcontrib>Khoury, Jean</creatorcontrib><creatorcontrib>Yardi, Ruta</creatorcontrib><creatorcontrib>Vegh, Deborah T</creatorcontrib><creatorcontrib>Butler, James</creatorcontrib><creatorcontrib>Lee, Hamin J</creatorcontrib><creatorcontrib>Deli-Peri, Victoria</creatorcontrib><creatorcontrib>Yao, Yi</creatorcontrib><creatorcontrib>Wang, Feng-Peng</creatorcontrib><creatorcontrib>Zhang, Xiao-Bin</creatorcontrib><creatorcontrib>Shakhatreh, Lubna</creatorcontrib><creatorcontrib>Siriratnam, Pakeeran</creatorcontrib><creatorcontrib>Neal, Andrew</creatorcontrib><creatorcontrib>Sen, Arjune</creatorcontrib><creatorcontrib>Tristram, Maggie</creatorcontrib><creatorcontrib>Varghese, Elizabeth</creatorcontrib><creatorcontrib>Biney, Wendy</creatorcontrib><creatorcontrib>Gray, William P</creatorcontrib><creatorcontrib>Peralta, Ana Rita</creatorcontrib><creatorcontrib>Rainha-Campos, Alexandre</creatorcontrib><creatorcontrib>Gonçalves-Ferreira, António J C</creatorcontrib><creatorcontrib>Pimentel, José</creatorcontrib><creatorcontrib>Arias, Juan Fernando</creatorcontrib><creatorcontrib>Terman, Samuel</creatorcontrib><creatorcontrib>Terziev, Robert</creatorcontrib><creatorcontrib>Lamberink, Herm J</creatorcontrib><creatorcontrib>Braun, Kees P J</creatorcontrib><creatorcontrib>Otte, Willem M</creatorcontrib><creatorcontrib>Rugg-Gunn, Fergus J</creatorcontrib><creatorcontrib>Gonzalez, Walter</creatorcontrib><creatorcontrib>Bentes, Carla</creatorcontrib><creatorcontrib>Hamandi, Khalid</creatorcontrib><creatorcontrib>O’Brien, Terence J</creatorcontrib><creatorcontrib>Perucca, Piero</creatorcontrib><creatorcontrib>Yao, Chen</creatorcontrib><creatorcontrib>Burman, Richard J</creatorcontrib><creatorcontrib>Jehi, Lara</creatorcontrib><creatorcontrib>Duncan, John S</creatorcontrib><creatorcontrib>Sander, Josemir W</creatorcontrib><creatorcontrib>Koepp, Matthias</creatorcontrib><creatorcontrib>Galovic, Marian</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Brain (London, England : 1878)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ferreira-Atuesta, Carolina</au><au>de Tisi, Jane</au><au>McEvoy, Andrew W</au><au>Miserocchi, Anna</au><au>Khoury, Jean</au><au>Yardi, Ruta</au><au>Vegh, Deborah T</au><au>Butler, James</au><au>Lee, Hamin J</au><au>Deli-Peri, Victoria</au><au>Yao, Yi</au><au>Wang, Feng-Peng</au><au>Zhang, Xiao-Bin</au><au>Shakhatreh, Lubna</au><au>Siriratnam, Pakeeran</au><au>Neal, Andrew</au><au>Sen, Arjune</au><au>Tristram, Maggie</au><au>Varghese, Elizabeth</au><au>Biney, Wendy</au><au>Gray, William P</au><au>Peralta, Ana Rita</au><au>Rainha-Campos, Alexandre</au><au>Gonçalves-Ferreira, António J C</au><au>Pimentel, José</au><au>Arias, Juan Fernando</au><au>Terman, Samuel</au><au>Terziev, Robert</au><au>Lamberink, Herm J</au><au>Braun, Kees P J</au><au>Otte, Willem M</au><au>Rugg-Gunn, Fergus J</au><au>Gonzalez, Walter</au><au>Bentes, Carla</au><au>Hamandi, Khalid</au><au>O’Brien, Terence J</au><au>Perucca, Piero</au><au>Yao, Chen</au><au>Burman, Richard J</au><au>Jehi, Lara</au><au>Duncan, John S</au><au>Sander, Josemir W</au><au>Koepp, Matthias</au><au>Galovic, Marian</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictive models for starting antiseizure medication withdrawal following epilepsy surgery in adults</atitle><jtitle>Brain (London, England : 1878)</jtitle><addtitle>Brain</addtitle><date>2023-06-01</date><risdate>2023</risdate><volume>146</volume><issue>6</issue><spage>2389</spage><epage>2398</epage><pages>2389-2398</pages><issn>0006-8950</issn><eissn>1460-2156</eissn><abstract>Abstract
More than half of adults with epilepsy undergoing resective epilepsy surgery achieve long-term seizure freedom and might consider withdrawing antiseizure medications. We aimed to identify predictors of seizure recurrence after starting postoperative antiseizure medication withdrawal and develop and validate predictive models.
We performed an international multicentre observational cohort study in nine tertiary epilepsy referral centres. We included 850 adults who started antiseizure medication withdrawal following resective epilepsy surgery and were free of seizures other than focal non-motor aware seizures before starting antiseizure medication withdrawal. We developed a model predicting recurrent seizures, other than focal non-motor aware seizures, using Cox proportional hazards regression in a derivation cohort (n = 231). Independent predictors of seizure recurrence, other than focal non-motor aware seizures, following the start of antiseizure medication withdrawal were focal non-motor aware seizures after surgery and before withdrawal [adjusted hazard ratio (aHR) 5.5, 95% confidence interval (CI) 2.7–11.1], history of focal to bilateral tonic-clonic seizures before surgery (aHR 1.6, 95% CI 0.9–2.8), time from surgery to the start of antiseizure medication withdrawal (aHR 0.9, 95% CI 0.8–0.9) and number of antiseizure medications at time of surgery (aHR 1.2, 95% CI 0.9–1.6). Model discrimination showed a concordance statistic of 0.67 (95% CI 0.63–0.71) in the external validation cohorts (n = 500). A secondary model predicting recurrence of any seizures (including focal non-motor aware seizures) was developed and validated in a subgroup that did not have focal non-motor aware seizures before withdrawal (n = 639), showing a concordance statistic of 0.68 (95% CI 0.64–0.72). Calibration plots indicated high agreement of predicted and observed outcomes for both models.
We show that simple algorithms, available as graphical nomograms and online tools (predictepilepsy.github.io), can provide probabilities of seizure outcomes after starting postoperative antiseizure medication withdrawal. These multicentre-validated models may assist clinicians when discussing antiseizure medication withdrawal after surgery with their patients.
Is it safe to begin withdrawal of antiseizure medications after epilepsy surgery? Ferreira-Atuesta et al. develop and validate models to predict seizure relapse after postoperative initiation of antiseizure medication withdrawal in adults. The models are available online at predictepilepsy.github.io.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>36415957</pmid><doi>10.1093/brain/awac437</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-4277-8000</orcidid><orcidid>https://orcid.org/0000-0003-3107-7871</orcidid><orcidid>https://orcid.org/0000-0002-1373-0681</orcidid><orcidid>https://orcid.org/0000-0002-8041-6377</orcidid><orcidid>https://orcid.org/0000-0002-7855-7066</orcidid><orcidid>https://orcid.org/0000-0001-6041-9661</orcidid><orcidid>https://orcid.org/0000-0001-7595-8887</orcidid><orcidid>https://orcid.org/0000-0003-0853-7163</orcidid><orcidid>https://orcid.org/0000-0002-2307-071X</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0006-8950 |
| ispartof | Brain (London, England : 1878), 2023-06, Vol.146 (6), p.2389-2398 |
| issn | 0006-8950 1460-2156 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2739430139 |
| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adult Anticonvulsants - adverse effects Epilepsies, Partial Epilepsy - drug therapy Epilepsy - surgery Epilepsy, Generalized - drug therapy Humans Neoplasm Recurrence, Local - drug therapy Seizures - drug therapy |
| title | Predictive models for starting antiseizure medication withdrawal following epilepsy surgery in adults |
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