Individualised prediction model of seizure recurrence and long-term outcomes after withdrawal of antiepileptic drugs in seizure-free patients: a systematic review and individual participant data meta-analysis

医学 荟萃分析 列线图 癫痫 不利影响 梅德林 研究异质性 儿科 内科学 精神科 政治学 法学
作者
Herm J. Lamberink,Willem M. Otte,Ada T. Geerts,Milen Pavlović,Julio Ramos-Lizana,Anthony G Marson,J. Overweg,Letícia Sauma,Luigi Maria Specchio,Michael B. Tennison,Tânia Marchiori Cardoso,Shlomo Shinnar,Dieter Schmidt,Karin Geleijns,Kees P. J. Braun
出处
期刊:Lancet Neurology [Elsevier BV]
卷期号:16 (7): 523-531 被引量:236
标识
DOI:10.1016/s1474-4422(17)30114-x
摘要

Background People with epilepsy who became seizure-free while taking antiepileptic drugs might consider discontinuing their medication, with the possibility of increased quality of life because of the elimination of adverse events. The risk with this action, however, is seizure recurrence. The objectives of our study were to identify predictors of seizure recurrence and long-term seizure outcomes and to produce nomograms for estimation of individualised outcomes. Methods We did a systematic review and meta-analysis, and identified eligible articles and candidate predictors, using PubMed and Embase databases with a last update on Nov 6, 2014. Eligible articles had to report on cohorts of patients with epilepsy who were seizure-free and had started withdrawal of antiepileptic drugs; articles also had to contain information regarding seizure recurrences during and after withdrawal. We excluded surgical cohorts, reports with fewer than 30 patients, and reports on acute symptomatic seizures because these topics were beyond the scope of our objective. Risk of bias was assessed using the Quality in Prognosis Studies system. Data analysis was based on individual participant data. Survival curves and proportional hazards were computed. The strongest predictors were selected with backward selection. Models were converted to nomograms and a web-based tool to determine individual risks. Findings We identified 45 studies with 7082 patients; ten studies (22%) with 1769 patients (25%) were included in the meta-analysis. Median follow-up was 5·3 years (IQR 3·0–10·0, maximum 23 years). Prospective and retrospective studies and randomised controlled trials were included, covering non-selected and selected populations of both children and adults. Relapse occurred in 812 (46%) of 1769 patients; 136 (9%) of 1455 for whom data were available had seizures in their last year of follow-up, suggesting enduring seizure control was not regained by this timepoint. Independent predictors of seizure recurrence were epilepsy duration before remission, seizure-free interval before antiepileptic drug withdrawal, age at onset of epilepsy, history of febrile seizures, number of seizures before remission, absence of a self-limiting epilepsy syndrome, developmental delay, and epileptiform abnormality on electroencephalogram (EEG) before withdrawal. Independent predictors of seizures in the last year of follow-up were epilepsy duration before remission, seizure-free interval before antiepileptic drug withdrawal, number of antiepileptic drugs before withdrawal, female sex, family history of epilepsy, number of seizures before remission, focal seizures, and epileptiform abnormality on EEG before withdrawal. Adjusted concordance statistics were 0·65 (95% CI 0·65–0·66) for predicting seizure recurrence and 0·71 (0·70–0·71) for predicting long-term seizure freedom. Validation was stable across the individual study populations. Interpretation We present evidence-based nomograms with robust performance across populations of children and adults. The nomograms facilitate prediction of outcomes following drug withdrawal for the individual patient, including both the risk of relapse and the chance of long-term freedom from seizures. The main limitations were the absence of a control group continuing antiepileptic drug treatment and a consistent definition of long-term seizure freedom. Funding Epilepsiefonds.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
大橙子发布了新的文献求助10
刚刚
领导范儿应助科研通管家采纳,获得10
1秒前
量子星尘发布了新的文献求助10
5秒前
明钟达完成签到 ,获得积分10
13秒前
byyyy完成签到,获得积分10
16秒前
高高的哈密瓜完成签到 ,获得积分10
20秒前
Rondab应助橙汁采纳,获得10
23秒前
读书的时候完成签到,获得积分10
25秒前
颜云尔完成签到,获得积分10
36秒前
孤独雨梅完成签到,获得积分10
39秒前
woobinhua完成签到 ,获得积分10
39秒前
雪落你看不见完成签到,获得积分10
41秒前
十月天秤完成签到,获得积分0
42秒前
依文完成签到,获得积分20
42秒前
ymr完成签到 ,获得积分10
43秒前
哦哦哦完成签到 ,获得积分10
44秒前
jzmupyj完成签到,获得积分10
44秒前
大橙子发布了新的文献求助10
47秒前
xdlongchem完成签到,获得积分10
48秒前
量子星尘发布了新的文献求助10
50秒前
小梦完成签到,获得积分10
51秒前
xuhang完成签到,获得积分10
51秒前
ZSHAN完成签到,获得积分10
52秒前
美满的机器猫完成签到,获得积分10
55秒前
王小磊完成签到,获得积分10
59秒前
谢花花完成签到 ,获得积分10
1分钟前
1分钟前
瓦罐完成签到 ,获得积分10
1分钟前
扁舟灬完成签到,获得积分10
1分钟前
Cpp完成签到 ,获得积分10
1分钟前
贤惠的老黑完成签到 ,获得积分10
1分钟前
ame1120发布了新的文献求助10
1分钟前
倦梦还完成签到,获得积分10
1分钟前
Sunrise完成签到,获得积分10
1分钟前
yyyy发布了新的文献求助10
1分钟前
自觉柠檬完成签到 ,获得积分10
1分钟前
ergatoid完成签到,获得积分10
1分钟前
Hao完成签到,获得积分10
1分钟前
月亮煮粥完成签到,获得积分10
1分钟前
欣欣完成签到 ,获得积分10
1分钟前
高分求助中
【提示信息,请勿应助】关于scihub 10000
Les Mantodea de Guyane: Insecta, Polyneoptera [The Mantids of French Guiana] 3000
徐淮辽南地区新元古代叠层石及生物地层 3000
The Mother of All Tableaux: Order, Equivalence, and Geometry in the Large-scale Structure of Optimality Theory 3000
Handbook of Industrial Diamonds.Vol2 1100
Global Eyelash Assessment scale (GEA) 1000
Picture Books with Same-sex Parented Families: Unintentional Censorship 550
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 4038128
求助须知:如何正确求助?哪些是违规求助? 3575831
关于积分的说明 11373827
捐赠科研通 3305610
什么是DOI,文献DOI怎么找? 1819255
邀请新用户注册赠送积分活动 892655
科研通“疑难数据库(出版商)”最低求助积分说明 815022