Individuals who develop drug-resistant epilepsy within a year after initial diagnosis have higher burden of mental and physical diseases one-year prior to epilepsy diagnosis as compared to those whose seizures were controlled during the same interval

AbstractObjectiveSignal analysis biomarkers, in an intra-operative setting, may be complementary tools to guide and tailor the resection in drug-resistant epilepsy patients. Unbiased assessment of biomarker performances are needed to evaluate their clinical usefulness and translation. We defined a realistic ground-truth scenario and compared the effectiveness of different biomarkers alone and combined to localize epileptogenic tissue.MethodsWe investigated the performances of univariate, bivariate and multivariate signal biomarkers applied to 1 minute inter-ictal intra-operative electrocorticography to discriminate between electrodes covering normal or pathologic activity in 47 drug-resistant people with epilepsy (temporal and extra-temporal) who had been seizure-free one year after the operation.ResultsThe best result using a single biomarker was obtained using the phase-amplitude coupling measure for which the epileptogenic tissue was localized in 16 out of 47 patients. Combining the whole set of biomarkers provided an improvement of the performances: 20 out of 47 patients. Repeating the analysis only on the temporal-lobe resections we reached a sensitivity of 93% (28 out of 30) combining all the biomarkers.ConclusionWe suggest that the assessment of biomarker performances on a ground-truth scenario is required to have a proper estimate on how biomarkers translate into clinical use. Phase-amplitude coupling seems the best performing single biomarker and combining biomarkers improves localization of epileptogenic tissue. However, sensitivity achieved is not adequate for the usage as a tool in the operation theater, but it can improve the understanding of pathophysiological process.

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Definitions of Drug-Resistant Epilepsy for Administrative Claims Data Research

Neurology ◽

10.1212/wnl.0000000000012514 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012514

Author(s):

Chloe E Hill ◽

Chun Chieh Lin ◽

Samuel W Terman ◽

Subhendu Rath ◽

Jack M Parent ◽

...

Keyword(s):

Claims Data ◽

Administrative Claims ◽

Drug Resistant ◽

Operating Characteristics ◽

Administrative Claims Data ◽

Current Drug ◽

Receiver Operating Characteristics Curve ◽

Epilepsy Diagnosis ◽

Drug Resistant Epilepsy ◽

International League

Objective:To assess accuracy of definitions of drug-resistant epilepsy applied to administrative claims data.Methods:We randomly sampled 450 patients from a tertiary health system with >1 epilepsy/convulsion encounter and >2 distinct antiseizure medications (ASMs) from 2014-2020 and >2 years of electronic medical records (EMR) data. We established a drug-resistant epilepsy diagnosis at a specific visit by reviewing EMR data and employing a rubric based in the 2010 International League Against Epilepsy definition. We performed logistic regressions to assess clinically-relevant predictors of drug-resistant epilepsy and to inform claims-based definitions.Results:Of 450 patients reviewed, 150 were excluded for insufficient EMR data. Of the 300 patients included, 98 (33%) met criteria for current drug-resistant epilepsy. The strongest predictors of current drug-resistant epilepsy were drug-resistant epilepsy diagnosis code (OR 16.9, 95% CI 8.8-32.2), >2 ASMs in the prior two years (OR 13.0, 95% CI 5.1-33.3), >3 non-gabapentinoid ASMs (OR 10.3, 95% CI 5.4-19.6), neurosurgery visit (OR 45.2, 95% CI 5.9-344.3), and epilepsy surgery (OR 30.7, 95% CI 7.1-133.3). We created claims-based drug-resistant epilepsy definitions to: 1) maximize overall predictiveness (drug-resistant epilepsy diagnosis; sensitivity 0.86, specificity 0.74, area under the receiver operating characteristics curve [AUROC] 0.80), 2) maximize sensitivity (drug-resistant epilepsy diagnosis or >3 ASMs; sensitivity 0.98, specificity 0.47, AUROC 0.72), and 3) maximize specificity (drug-resistant epilepsy diagnosis and >3 non-gabapentinoid ASMs; sensitivity 0.42, specificity 0.98, AUROC 0.70).Conclusions:Our findings provide validation for several claims-based definitions of drug-resistant epilepsy that can be applied to a variety of research questions.

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