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Predictive models for starting antiseizure medication withdrawal following epilepsy surgery in adults

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机构: [1]Department of Clinical and Experimental Epilepsy (DCEE), NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, WC1N 3BG UK [2]Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK [3]Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA [4]Cleveland Clinic Epilepsy Center, Cleveland, USA [5]Constantiaberg Mediclinic Hospital, Division of Neurology, Neuroscience Institute, University of Cape Town, South Africa [6]Department of Epilepsy Surgery, Shenzhen Children's Hospital, Shenzhen, Guangdong, China [7]Department of Functional Neurosurgery, Xiamen Humanity Hospital, Xiamen, FuJian, China [8]Departnent of Neuroscience, Central Clinical School, Alfired Health, Monash University, L evel 6, Melbourne VIC 3000, Australia [9]Departments of Medicine and Neurology, The Royal Melboune Hospital, The University of Melboune, Parkville, VIC 3050, Australia [10]Neurology Department, Alfred Health, Melboune, VIC 3000, Australia [11]Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, UK [12]Department of Neurology, 3rd Floor, West Wing, John Radcliffe Hospital, Oxford 0X3 9DU, UK [13]Department of Neurology, University Hospital of Wales, Cardiff, CF144XW, UK [14]The Wales Epilepsy Unit, Department of Neurology, University Hospital of Wales and Division of Psychological Medicine and Clinical Neurosciences Cardiff, Cardiff University, Cardiff, CF 144XW, UK [15]Centro de Referencia para Epilepsias R efratarias (member of EpiCare). Hospital de Santa Maria - Centro Hospitalar Universitario Lisboa Norte. Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal [16]Epilepsy Center, Instituto Roosevelt, Bogota, Colombia [17]University of Michigan Department of Neturology, Ann Arbor, MI 48109, USA [18]Departnent of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland [19]Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands [20]Depatment of Child Neurology, University Medical Center Utrecht, Utrecht, The Netherlands [21]Department of Medicine, Austin Health, The University of Melbourne [22]Comprehensive Epilepsy Program, Austin Health, Heidelberg, VIC 3084, Auustralia [23]Department of Neurosurgery, the First Afliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China [24]Shenzhen Epilepsy Center (Shenzhen Children's Hospital and Shenzhen Second People's Hospital), Shenzhen, China [25]Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China [26]Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede 2103SW, The Netherlands
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关键词: epilepsy epilepsy surgery antiseizure medication withdrawal prognosis

摘要:
More than half of adults with epilepsy undergoing resective epilepsy surgery achieve long-term seizure freedom and might consider withdrawing antiseizure medications (ASMs). We aimed to identify predictors of seizure recurrence after starting postoperative ASM 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 ASM withdrawal following resective epilepsy surgery and were free of seizures other than focal non-motor aware seizures before starting ASM 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 ASM withdrawal were focal non motor-aware seizures after surgery and before withdrawal (adjusted hazards 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 ASM withdrawal (aHR 0.9, 95% CI 0.8-0.9), and number of ASMs 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 ASMs withdrawal. These multicentre-validated models may assist clinicians when discussing ASM withdrawal after surgery with their patients.© 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.

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出版当年[2023]版:
大类 | 1 区 医学
小类 | 1 区 临床神经病学 1 区 神经科学
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大类 | 1 区 医学
小类 | 1 区 临床神经病学 1 区 神经科学
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出版当年[2023]版:
Q1 CLINICAL NEUROLOGY Q1 NEUROSCIENCES
最新[2023]版:
Q1 CLINICAL NEUROLOGY Q1 NEUROSCIENCES

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第一作者:
第一作者机构: [1]Department of Clinical and Experimental Epilepsy (DCEE), NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, WC1N 3BG UK [2]Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK [3]Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA
通讯作者:
通讯机构: [1]Department of Clinical and Experimental Epilepsy (DCEE), NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, WC1N 3BG UK [2]Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK [18]Departnent of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland [*1]Department of Neurology University Hospital Zurich rauenklinikstrasse 8091 Zurich Switzerland
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